Mystery Solved?
Thankfully I can keep a very long and complicated story, relatively simple. For now I’ll leave a 18-year rectus abdominis hernia, requiring two surgeries, out of it and concentrate on my newest discovery – interchondral subluxation, or Slipping Rib Syndrome.
Figure 1 – Slipping rib syndrome happens when the cartilage that attaches two lower ribs together becomes loose or unstable.
A slipping rib can irritate the intercostal nerve that runs between your ribs. This probably triggers the sharp, localized pain you feel at first. Eventually, it may also inflame the soft tissues around your rib. This may cause a more diffuse type of pain that’s harder to locate in one place. It might feel like lower chest pain or upper abdominal pain. Sometimes, it radiates to your upper back or one of your flanks.
How do you fix a slipping rib?
Sometimes, a slipping rib heals on its own. If it’s not bothering you too much, your provider might suggest waiting and watching to see if it does. They’ll suggest conservative treatments to ease your pain, like:
- Hot/cold therapy
- Over-the-counter pain medications, like NSAIDs
- A period of rest, followed by physical therapy
If this approach isn’t working, they might suggest an intercostal nerve block — an injection of medication to calm your irritated nerve. This provides temporary relief, and sometimes it helps the healing process.
Surgery
If your symptoms don’t improve over the long term, you might need surgery to fix slipping rib syndrome. Surgeons use minimally invasive methods, like video-assisted thoracic surgery (VATS), whenever possible.
Surgery to fix a slipping rib might mean:
- Tightening or repairing loose ligaments or cartilage with stitches (stabilization)
- Removing the damaged or detached cartilage tip (partial rib resection)
- Using metal plates to separate ribs that are sliding together (rib plating)
Outlook / Prognosis
What can I expect if I have this condition?
Getting a diagnosis for slipping rib syndrome is half the battle. Once your healthcare provider recognizes the condition, healing can begin. Many people find relief over time through conservative treatments.
Not everyone will need surgery for slipping rib syndrome, but surgery is usually successful if you do. Occasionally, there’s an unrecognized cause that leads to symptoms returning later in another rib.
A note from Cleveland Clinic
Slipping rib pain can be intense, confusing and frightening, especially when your healthcare provider can’t explain it. It’s incredibly frustrating to have chronic pain with no diagnosis or treatment plan.
Fortunately, awareness of slipping rib syndrome is gradually increasing. And for all its mystery, it’s not an incurable or life-threatening disease — just an anatomical issue that surgery can fix.
Snippets above from https://my.clevelandclinic.org/health/diseases/slipping-rib-syndrome
Slipping rib syndrome (SRS) is a condition in which the interchondral ligaments are weakened or disrupted and have increased laxity, causing the costal cartilage tips to subluxate (partially dislocate). This results in pain or discomfort due to pinched or irritated intercostal nerves, straining of the intercostal muscles, and inflammation. The condition affects the 8th, 9th, and 10th ribs, referred to as the false ribs, with the 10th rib most commonly affected.
Wikipedia
Diagnosis
Diagnosing slipping rib syndrome is predominantly clinical,[10][11] with a physical examination of the affected rib being the most commonly utilized. A technique known as the “hooking maneuver” is commonly used amongst medical professionals to diagnose slipping rib syndrome. The examiner will hook their fingers under the costal margin, then pull in an anterior (outward) and superior (upward) direction, with a positive result when movement or pain is replicated during this action.[7]
Plain radiographs, CT scans, MRI, and standard ultrasound, are all unable to visualize the cartilage affected by SRS; however, they are often used to exclude other conditions.[3] Dynamic ultrasound is occasionally used to evaluate the dynamic laxity or displacement of the cartilage;[10] however, it has been said to be not much superior to that of a physical examination from an experienced physician, as a diagnosis is dependent on the technician’s expertise and knowledge of the condition.[9] A positive result of a dynamic ultrasound for slipping rib syndrome requires an observed subluxation of the cartilage, which may be elicited with the Valsalva, crunch, or other maneuvers.[12][13] Nerve blocking injections have also been utilized as a diagnostic method by noting the absence of pain following an injection to the intercostal nerves of the affected ribs.[14][11]
I passed the “hooking maneuver” test with flying colors. I can pull at least one of my false ribs (I suspect 10), in and out of the joint with an audible thud. A positive result of this test is considered definitive but I need to find a practitioner to confirm my result.
Here are some websites with more info…
https://www.ribinjuryclinic.com/conditions/slipped-rib-syndrome (has a cool 3D moveable model)