Slipping Rib Syndrome

The entity, of “Slipping Rib Syndrome,” which could be mistaken for a gastronomical error at The Boathouse, is also called Cyriax syndrome.  A recent brief report (L Calvete et al. J Pediatric 2016; 172: 216) describes a typical case.  This teenager had a 1-year history of “brief, episodic, sharp upper left abdominal pain, accompanied by a [subtle] chest wall deformity, which started after physical activity.”

Key points:

  • This disorder is most common in middle-aged females but can occur at any age
  • It can result from hyper mobility of the false ribs, allowing “the affected rib to sublet or ‘slip’ under the adjacent rib,..and cause pain
  • The disorder can be elicited with the ‘hooking’ maneuver.  “In this test, the patient lies in the supine position, while the clinician hooks his or her fingers beneath the costal margins of the affected side, displacing them upward and anteriorly pulling gently.  A positive test reproduces pain.”
  • Treatment: avoidance of displacement and mild analgesics

My take: I’ve only seen this condition once but think it is important to consider in patients presenting with intermittent abdominal pain.

Atlanta Zoo 2016

Atlanta Zoo 2016

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