Slipping rib syndrome (SRS) is a highly underdiagnosed disorder caused by weak or loose fibrous attachment of the ends of the ribs at the margin of the rib cage. The laxity leads to excessive mobility of the rib cartilages that irritate the intercostal nerves, apply strain on the chest muscles, and cause inflammation near the rib cage margin. SRS is rarely referenced in surgical textbooks, and patients with SRS may withstand months or years of unresolved pain before being correctly diagnosed.
Symptoms consist of pain at the margin of the rib cage that is exacerbated with movement, particularly with the twisting or bending of the torso. There may be episodes of inflammation and swelling at the affected areas. The pain may severely limit everyday activities as well as physical exertion such as sports.
To diagnose, your surgeon will usually do a hooking maneuver on physical examination. In this maneuver, the surgeon’s fingers are hooked under the margin of the affected ribs. The slipping movement of the affected ribs is reproduced. If the patient reports pain, then the hooking maneuver is positive and provides sufficient evidence to give a diagnosis of SRS.
Conservative treatments, such as rest, non-steroidal anti-inflammatory drugs (NSAIDs), and physical therapy, have provided relief for many patients; but surgical resection of the affected rib cartilages is the only treatment to provide definitive long-term pain relief and return to full activity.
Surgical treatment involves resection or removal of the affected rib cartilages and decompression of the intercostal nerves. Dr. Liu has a decade of experience operating on the chest and in the chest. He is an expert in rib resection. Dr. Liu performs rib resection through an incision directly over the affected ribs. He may also combine the rib resection with an abdominoplasty approach, which offers full surgical access to the rib cage margin and can treat multiple sites of slipping ribs through one incision, which is concealed below the waistline. Dr. Liu also has fellowship training in peripheral nerve surgery, enabling him to expertly identify and decompress the intercostal nerves.
Rib resection may be performed as an outpatient (same-day) surgery or with an overnight hospital admission. For the best healing, patients should refrain from heavy lifting and other strenuous physical activity for 4 weeks after surgery. Many patients report that the pain from slipping rib syndrome resolves almost immediately after surgery, as the problematic ribs are no longer rubbing against each other or irritating the intercostal nerves.
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