(clicking rib syndrome, painful rib syndrome, displaced ribs, interchondral subluxation, Cyriax syndrome)
A condition in which the interchondral ligaments are weakened or disrupted and have increased laxity, causing the costal cartilage tips to subluxate (partially dislocate).
It affects the 8-10th ribs (most commonly, the 10th rib). It can present at one or both sides.
(Types of the ribs)
• true ribs: 1st-7th ribs, attached directly to the sternum by costal cartilages.
• false ribs: 8th-10th ribs, that do not join the sternum directly but connected to the 7th rib by cartilage.
• floating ribs: 11th-12th ribs, half the size of the others, that do not reach to the front of the body.
(Symptoms)
• pain or discomfort in the lower chest or upper abdomen: Most common. Episodic lasting minutes to hours, from a minor nuisance to severely impacting quality of life.
• sensation of "popping" or "clicking" of the lower ribs: As a result of subluxation of the cartilaginous joints.
• intense, sharp pain that can radiate from the chest to the back
Stretching, reaching, coughing, sneezing, lifting, bending, sitting, sports activities, and respiration may exacerbate the symptoms.
(Causes)
• pinched or irritated intercostal nerves, straining of the intercostal muscles, and inflammation.
• physical trauma: Seen in athletes for full-contact sports such as hockey, wrestling, and American football and for swimmers resulting from repetitive upper body movements.
• unstable bifid rib: A congenital abnormality.
• generalised joint hypermobility: A congenital abnormality. An ability to exceed the joints beyond the normal range.
(Diagnosis)
• movement or pain by the hooking maneuver (pulling anterosuperiorly with the hooked fingers under the costal margin).
• dynamic ultrasound (physical examination by an experienced physician is better): Evaluates the dynamic laxity or displacement of the cartilage. For subluxation of the cartilage, the Valsalva, crunch, or other maneuvers may be used.
• nerve blocking injections to the intercostal nerves of the affected ribs: Absence of pain.
Plain radiographs, CT scans, MRI, and standard ultrasound, are all unable to visualize the affected cartilage. However, they are often used to exclude other conditions.
(Differential diagnosis)
• costochondritis: Involves the cartilage of the thoracic wall. Exhibit no swelling. Chest pain, typically diffused with the upper costochondral or sternocostal junctions most frequently involved. (Unlike slipping rib syndrome, which involves the lower rib cage.)
• Tietze syndrome: Often associated with swelling and swelling of the costochondral, sternocostal, and sternoclavicular joints, typically involves the 2nd-3rd ribs, usually a result of infectious, rheumatologic, or neoplastic processes. (Unlike slipping rib syndrome, which exhibits no swelling.)
• pleurisy
• rib fracture
• gastric ulcer
• cholecystitis
• esophagitis
• hepatosplenic abnormalities
(Comparison)
• slipping rib syndrome: Affects the false ribs (8th-10th ribs). Intense, sharp pain that can radiate from the chest to the back.
• twelfth rib syndrome: Affects the floating ribs (11th-12th ribs), typically presents as lower back, abdominal, and groin pain. Negative by the hooking maneuver.
(Treatment)
• conservative measures: Especially for those in which the symptoms are minor.
- - limit activity
- - ice
- - pain medication: E.g. nonsteroidal anti-inflammatory drugs (NSAIDs).
• non-invasive methods: Typically for relief or symptom management.
- - osteopathic manipulation treatment
- - physical therapy
- - chiropractic treatment
- - acupuncture
• topical medications: For temporary relief of symptoms.
- - diclofenac gel
- - lidocaine transdermal patches
• nerve blocking injections: Minimally invasive procedures. Consists of steroidal or local anesthetic agents. Seen as temporary, repeated injections are necessary.
• surgical procedures
- - costal cartilage removal: Removal of the cartilage affected from the sternum to the boned portions of the ribs, with or without preserving the perichondrium.
- - rib resection: Removal of small bone portions of the affected ribs.
- - laparoscopic costal cartilage removal: Minimally invasive. Intra-abdominal approach. The affected cartilage is excised from the sternocostal junction to the costochondral junction.
- - rib stabilization with plating: Prevents subluxation of the affected ribs while preserving thorax mobility. The ribs are stabilized with bioabsorbable plates anchored onto stable non-affected ribs above the affected ribs. The plates are vertically placed onto the ribs and secured with non-absorbable sutures.
Ещё видео!