SRS Resources & Studies

Publications and Case Studies

A Review of SRS-Diagnostic and Treatment Updates to a Rare and Challenging Problem

Isheeta Madeka, MD, Sneha Alaparthi, MD, Marisa Moreta, MD, Shawn Peterson, MD, Jeffrey J. Mojica, MD, Johanes Roedl, MD and Olubenga Okusanya, MD

Clin. Med. 2023, 12(24), 7671; doi:10.3390,jcm12247671

Published: 14 December 2023

Redefining the costal margin: A pilot study

Mujahed Laswi, MD, Rich Lesperance, MD, Adam Kaye, MD, Zachary Bauman, DO, Adam Hansen, MD, Jennifer Achay, NRP, FcEHS, Steven Kubalak, Ph.D., and Evert Eriksson, MD

Journal of Trauma and Acute Care Surgery 93(6):p 762-766, December 2022. | DOI:10.1097/TA.0000000000003792

Published: 2022 / 2023 PDF

Initial outcomes using cryoablation in the surgical management of slipping rib syndrome

Krista Lai, R Scott Eldredge, Melissa Nguyen, Benjamin E. Padilla, Lisa E. McMahon

Published: January 04, 2023

Almost slipped through the crack: Pediatric patient with bilateral slipped rib syndrome and twelfth rib syndrome of the eleventh ribs

Journal of Pediatric Surgery Case Reports- Volume 85, October 2022, 102408

A new sign of the slipping rib syndrome?- Case Report

Rosalia Romano, Diego Gavezzoli,Maria Sole Gallazzi and Mauro Roberto Benvenuti

Interactive CardioVascular and Thoracic Surgery, Volume 34, Issue 2, Pages 331–332

Published: February 2022

A Comprehensive Review of Slipping Rib Syndrome: Treatment and Management

National Library of Medicine PMCID: PMC7901126 PMID: 33633425 Published: Oct 15, 2020

Vertical rib plating for the treatment of slipping rib syndrome

Lisa E. McMahon, Nicole A. Salevitz, David M. Notrica Published: October 05, 2020

Minimally Invasive Repair of Adult Slipped Rib Syndrome Without Costal Cartilage Excision

Adam J. Hansen, MD Alper Toker, MD Jeremiah Hayanga, MD Percival Buenaventura, MD Charlotte Spear, MD Ghulam Abbas, MD Published: April 21, 2020

Slipping Rib Syndrome, a review of evaluation, diagnosis, and treatment.

Lisa E McMahon PMID: 30078490 DOI: 10.1053/j.sempedsurg.2018.05.009

Published Epub: May 27, 2018

Cyriax' syndrome: slipping rib syndrome; a review, analysis, and commentary

Llewellyn, Craig Hartman, "Cyriax' syndrome: slipping rib syndrome; a review, analysis, and commentary" (1963). Yale Medicine Thesis Digital Library. 2872. PDF

Published: From 1963

SURGICAL PROCEDURES

Surgery may be recommended if the condition causes continuous or severe pain and if other treatments are ineffective.

It is important to note that everyone has different anatomy and conditions. If you are a candidate for SRS surgery, your surgeon should provide a personalized surgery plan based on your specific condition. They should also explain which surgical techniques, such as resection, suturing, plating, or combinations, will lead to successful surgical outcomes.

LEARN MORE ABOUT SURGICAL PROCEDURES

Twelfth rib syndrome

Almost slipped through the crack: Pediatric patient with bilateral slipped rib syndrome and twelfth rib syndrome of the eleventh ribs

Journal of Pediatric Surgery Case Reports- Volume 85, October 2022, 102408

Treatment and Management of Twelfth Rib Syndrome: A Best Practices Comprehensive Review

Twelfth rib syndrome, or slipping of the 12th rib, is an often overlooked cause

of chronic chest, back, flank, and abdominal pain from irritation of the 12th intercostal nerve.

Published: Pain Physician 2021: 24:E45-E50

Twelfth rib syndrome: a case report

Twelfth rib syndrome is a rare condition that causes severe pain in the loin. The diagnosis of this phenomenon is based on the patient’s medical history and physical examination findings.

Published online 2020 Sep 4, doi: 10.1177/0300060520952651

Twelfth rib syndrome - case series

Twelfth rib syndrome- an often missed differential diagnosis of hypogastric & lumbar pain: case series: Published: February 02, 2014 DOI: 10.5455/2320-1770.ijrcog20140357

Twelfth-rib syndrome simulating intra-abdominal disease

A remarkable syndrome of bilateral intercostal neuralgia with pain in the loin, lower abdomen, groin, and thigh was cured by resection of the 11th and 12th ribs. Case report. Published: May 1988

Studies of a possible link between SRS

The 12th Rib Syndrome and the first lumber nerves relationship

”12th rib syndrome” is Involved in the floating ribs (11th–12th), a hypermobility of the 11th-12th ribs irritating the surrounding tissues and nervous systems.

“ Iliocostal impingement syndrome,” some called "L1 syndrome", is Involved in the lowest ribs (11th–12th) and describes the nerve impingement beneath the lowest ribs, near the spine. This syndrome is a pathologically short distance between the lower ribs and the iliac crest caused by being too close to the L1 transverse processes.

Learn more About The 12th Rib Syndrome and the first lumber nerves relationship

Costochondritis

Costochondritis is a chest wall pain caused by inflammation of the costal cartilage or the area where the ribs meet the sternum, known as sternal articulations.

Tietze Syndrome

Tietze Syndrome is an atypical cause of anterior chest pain characterized by localized tenderness and non-suppurative swelling, usually associated with the 2nd or 3rd costal cartilages unilaterally.

Slipping Rib Syndrome, Functional Lower Rib Disorders, and Abdominal Vascular Compression Syndromes

Dr. Kurtis Kim, (International Foundation of Abdominal Vascular Compression Syndromes) and Dr. Adam Hansen,(cardiothoracic surgery) video presentation

Abdominal Vascular Compression Syndromes

Kurtis Kim, MD, FACS, RPVI- International Foundation of Abdominal Vascular Compression Syndromes, Baltimore, MD VOLUME 77, ISSUE 4, SUPPLEMENT, 50S, APRIL 2023

Hypermobile Ehlers-Danlos Syndrome

An inherited connective tissue disorder that is caused by defects in a protein called collagen. It is generally considered the least severe form of Ehlers-Danlos syndrome (EDS), although significant complications can occur.

Outcomes in adult pectus excavatum patients undergoing Nuss repair

Pectus excavatum (PEx) is one of the most common congenital chest wall deformities. Depending on the severity, presentation of PEx may range from minor cosmetic issues to disabling cardiopulmonary symptoms.

Other Resources

The American National Library of Medicine

PubMed® comprises more than 35 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher websites.

Pain terms and definitions

The International Association on the Study of Pain (IASP) is the leading global organization supporting the study and practice of pain and pain relief. IASP brings together scientists, clinicians, healthcare providers, and policymakers worldwide in pursuit of their mission to bring relief to those in pain.

DOCINFO

DocInfo provides professional background information on more than one million licensed doctors in the U.S. Before you schedule your next check-up, make sure your doctor checks out.

NORD – National Organization for Rare Disorders

NORD was first national nonprofit to represent all individuals and families affected by rare disease. Today we’re the only organization working at the intersection of care, research, policy and community for all rare diseases.

The Classification of Human Ribs

Anatomy Standard, Jānis Šavlovskis & Kristaps Raits

Common Gastrointestinal (GI) symptoms

The ACG has created this special resource section that features the College’s wealth of scientifically-based educational material and information, the latest related research from The American Journal of Gastroenterology, and expert insight to help patients understand common GI symptoms and how these symptoms should be appropriately and effectively managed.

Physiopedia

Our mission is to improve global health through universal access to rehabilitation knowledge.

Musculoskeletal Key

Musculoskeletalkey adapts to your schedule, workflow preferences and information needs, making it easier for you to find and apply relevant knowledge quickly.

The Rib Injury Clinic is led by Mr Ian Hunt, a consultant Thoracic Surgeon who works with other specialists to offer the latest surgical and non-surgical treatments for all types of rib, chest wall and breastbone injuries and problems in the UK.

Mr Naveed Alam is a Thoracic Surgeon who has been in consultant practice in Melbourne since 2005. Mr Alam performs a newer surgical treatment for Slipping Rib Syndrome (SRS) called Chest Wall Stabilisation.

PUBLISHED NEWS AND MAGAZINE ARTICLES

Why Aren’t More of Us Talking About Slipping Rib Syndrome?

The New York Magazine, 'the cut' has featured an article in their latest edition. By Ashley Abramson Apr. 14, 2023

The World Health Organization has classified Slipping Rib Syndrome- FB82.Y

in the International Classification of Diseases 11th Revision (ICD 11)

The global standard for diagnostic health information. January 2023

From Under the Radar to Over the Moon: How Three Patients with Slipping Rib Syndrome Got Their Lives Back

Penn Medicine News. November 02, 2020

Slipping Through: One Patient’s Road to a Rare Diagnosis

Penn Medicine News. September 03, 2019

REFERENCES

A Review of Slipping Rib Syndrome: Diagnostic and Treatment Updates to a Rare and Challenging Problem, . J.Clin.Med. 2023,12,7671. doi.org/ 10.3390/jcm12247671, Published:14 December 2023
Redefining the costal margin: A pilot study, Published online: September 19, 2022. DOI: 10.1097TA.0000000000003792
Foley Davelaar CM. A clinical review of slipping rib syndrome. Curr Sports Med Rep. 2021;20(3):164–168.
McMahon LE. Slipping rib syndrome: a review of evaluation, diagnosis, and treatment. Semin Pediatr Surg. 2018;27(3):183–188.
KhanNAJ, WaseemS, UllahS, MehmoodH.Slipping rib syndrome in a female adult with long standing intractable upper abdominal pain. Case Rep Med. 2018; 2018:7484560.
Turcios NL. Slipping Rib Syndrome: An elusive diagnosis. Paediatr Respir Rev. 2017;22:44–46.
Graeber GM, Nazim M. The anatomy of the ribs and the sternum and their relationship to chest wall structure and function. Thorac Surg Clin. 2007; 17(4):473–489 vi.
NetterFH, Colacino S. Atlas of human anatomy. 2nd ed.East Hanover, N.J.: Novartis; 1997:525 of plates p.
Fares MY, Dimassi Z, Baydoun H, Musharrafieh U. Slipping rib syndrome: solving the mystery of the shooting pain. Am J Med Sci. 2019;357(2): 168–173.
Gress K, Charipova K, Kassem H, Berger AA, Cornett EM, Hasoon J, et al. A comprehensive review of slipping rib syndrome: treatment and management. Psychopharmacol Bull. 2020;50(4 Suppl 1):189–196.
Hansen AJ, Toker A, Hayanga J, Buenaventura P, Spear C, Abbas G. Minimally invasive repair of adult slipped rib syndrome without costal cartilage excision. Ann Thorac Surg. 2020;110(3):1030–1035.
Rudolph HC, Nam BT. Combined excision of costal cartilage and rib plating for slipped rib syndrome. Ann Thorac Surg. 2022;113(3):e207–e209.
Bong J, Healey D. Slipping rib syndrome. J Med Imaging Radiat Oncol. 2022;66(3):409–410.
Chhipa I, Cheesman Q. Slipping rib syndrome in an adolescent wrestler. BMJ Case Rep. 2020;13(1):e232514.
van Delft EA, van Pul KM, Bloemers FW. The slipping rib syndrome: a case report. Int J Surg Case Rep. 2016;23:23–24.
Cyriax EF. On various conditions that may simulate the referred pains of visceral disease, and a consideration of these from the point of view of cause and effect. Practitioner. 1919;102:314–322.
Wright JT. Slipping-rib syndrome. Lancet. 1980;2(8195 pt 1):632–634. Fraser JA, Briggs KB, Svetanoff WJ, St Peter SD. Long-term outcomes and satisfaction rates after costal cartilage resection for slipping rib syndrome. J Pediatr Surg. 2021;56(12):2258–2262.
Mazzella A, Fournel L, Bobbio A, Janet-Vendroux A, Lococo F, Hamelin EC, et al. Costal cartilage resection for the treatment of slipping rib syndrome (cyriax syndrome) in adults. J Thorac Dis. 2020;12(1):10–16.
Lilly Su a, Alicia Greene b, Anthony Tsai c, Almost slipped through the crack: Pediatric patient with bilateral slipped rib syndrome and twelfth rib syndrome of the eleventh ribs doi.org/10.1016/j.epsc.2022.102408 Received 22 July 2022; Accepted 30 July 2022 Journal of Pediatric Surgery Case Reports 85 (2022) 102408
Pain Physician 2020; 23:E45-E50 • ISSN 2150-1149 Treatment and Management of Twelfth Rib Syndrome: A Best Practices Comprehensive Review
Gress K, Charipova K, Kassem H, et al. A comprehensive review of slipping rib syndrome: treatment and management. Psychopharmacol Bull 10 15 2020;50(4 Suppl 1):189–96.
McMahon L.E. Slipping Rib Syndrome: a review of evaluation, diagnosis and treatment. Semin Pediatr Surg Jun 2018;27(3):183–8. doi.org/10.1053/ j.sempedsurg.2018.05.009.
Khan N.A.J, Waseem S, Ullah S, Mehmood H. Slipping rib syndrome in a female adult with longstanding intractable upper abdominal pain. Case Rep Med 2018; 2018:7484560. doi.org/10.1155/2018/7484560.
Urits I, Noor N, Fackler N, et al. Treatment and management of twelfth rib syndrome: a best practices comprehensive review. Pain Physician 01 2021;24(1): E45–50.
Heinz G.J, Zavala D.C. Slipping rib syndrome. JAMA Feb 21 1977;237(8):794–5.
Van Tassel D, McMahon L.E, Riemann M, Wong K, Barnes C.E. Dynamic ultrasound in the evaluation of patients with suspected slipping rib syndrome. Skeletal Radiol May 2019;48(5):741–51. doi.org/10.1007/s00256-018-3133-z.
Fares M.Y, Dimassi Z, Baydoun H, Musharrafieh U. Slipping rib syndrome: solving the mystery of the shooting pain. Am J Med Sci. 02 2019;357(2):168–73 doi.org/10.1016/j.amjms.2018.10.007.
Cranfield K.A, Buist R.J, Nandi P.R, Baranowski A.P. The twelfth rib syndrome. J Pain Symptom Manag Mar 1997;13(3):172–5 doi.org/10.1016/s0885- 3924(96)00271-0.
Hansen A.J, Toker A, Hayanga J, Buenaventura P, Spear C, Abbas G. Minimally invasive repair of adult slipped rib syndrome without costal cartilage excision. Ann Thorac Surg Sep 2020;110(3):1030–5. doi.org/10.1016/j.athoracsur.2020.02.081. .
Machin DG, Shennan JM. Twelfth rib syndrome: A differential diagnosis of loin pain. Br Med J 1983; 287:586.
Cranfield KAW, Buist RJ, Nandi PR, Baranowski AP. The twelfth rib syndrome. J Pain Symptom Manage 1997; 13:172-175.
Keoghane SR, Douglas J, Pounder D. Twelfth rib syndrome: A forgotten cause of flank pain. BJU Int 2009; 103:569-570.
Germanovich A, Ferrante FM. Multimodal treatment approach to painful rib syndrome: Case series and review of the literature. Pain Physician 2016; 19:E465-E471.
Khan NAJ, Waseem S, Ullah S, Mehmood H. Slipping rib syndrome in a female adult with longstanding intractable upper abdominal pain. Case Rep Med 2018; 2018:3-6.
Migliore M, Signorelli M, Caltabiano R, Aguglia E. Flank pain caused by slipping rib syndrome. Lancet 2014;383:844.
Scott BB, Scott EM. Painful rib syndrome: A review of 76 cases. Gut1993; 34:1006-1008.
Turcios NL. Slipping rib syndrome: An elusive diagnosis. Paediatr Respir Rev 2017; 22:44-46.
Fam AG, Smythe HA. Musculoskeletal chest wall pain. CMAJ 1985; 133:379-389.
Vadhanan P, Hussain M, Prakash R. The subcostal nerve as the target for nerve stimulator guided transverse abdominis plane blocks: A feasibility study. Indian J Anaesth 2019; 63:265-269.
Jalovaara P, Rämö J, Lindholm R. Twelfth-rib syndrome simulating intra-abdominal disease. Case report. ActaChir Scand. 1988;154:407-408.
Udermann BE, Cavanaugh DG,Gibson MH, Doberstein ST, Mayer JM, Murray SR. Slipping rib syndrome in a collegiate swimmer: A case report. J Athl Train 2005; 40:120-122.
Kumar R, Ganghi R, Rana V, Bose M.The painful rib syndrome. Indian J Anaesth 2013; 57:311-313.
Bonica JJ. The management of pain: The future. In: Stanley TH, Ashburn MA,
Fine PG (eds). Anesthesiology and Pain Management. Developments in Critical Care Medicine and Anesthesiology. Vol24. Dordrecht, Springer, 1991: pp.73-92.
Wells JCD. Twelfth rib syndrome. Br Med J 1983; 287:1725.
Wynne A, Nelson M, Nordin B. Costoiliac impingement syndrome. J Bone JtSurg Br. 1985; 67:124-125.
Cranfield KA, Buist RJ, Nandi PR, Baranowski AP. The twelfth rib syndrome. Journal of Pain and Symptom Management. 1997;13:172-5.
Spence EK, Rosato EF. The slipping rib syndrome Arch Surg. 1983;118:1330-2.
Gillian A. Hawker, Samra Mian, Tetyana Kendzerska, Melissa French. Measures of adult pain. Arthritis Care & Research. 2011;63:240-52.
Heinz GJ, Zavala DC. Slipping rib syndrome Diagnosis using the hooking maneuvers. JAMA. 1977;237:794-5.
Cyriax EF. On various conditions that may simulate the referred pains of visceral disease, and a consideration of these from the point of view of cause and effect. Practitioner. 1919;102:314-9.
Scott EM, Scott BB. Painful rib syndrome. Gut.1993;34:1006-8.
Machin DG, Shennan JM. Twelfth rib syndrome: a differential diagnosis of loin pain. Br Med J (Clin Res Ed). 1983;287:586.
Roaf R. 1958 Rotation movements of the spine with special reference to scoliosis. J Bone Joint Surg Br. 1958;40-B(2):312–32.
Riddle HFV, Roaf R. Muscle imbalance in the causation of scoliosis. Lancet, 1. 1955;268(6877):1245–7. PMID:14382561.
Fidler MW, Jowett RL, Troup JDG. Histochemical study of the function of multifidus in scoliosis. In: Zorab PA, editor. Scoliosis and Muscle. London: William Heinemann Medical Books Ltd; 1974. p. 184–92.
Fidler MW, Jowett RL. Muscle imbalance in the aetiology of scoliosis. J Bone Joint Surg Br. 1976;58(2):200–1.
Zuk T. The role of spinal and abdominal muscles in the pathogenesis of scoliosis. Journal of Bone and Joint Surgery. 1962;44-B:102–5.
Schmitt O. Electrical Stimulation of intercostal muscles in idiopathic scoliosis. Proceedings of the Third Meeting of ISAO, Motor Prosthesis and Bone Stimulation, Artificial Organs. 1981;5(Suppl):589–93.
Roaf R. The intercostal muscles and conditioned reflexes in the control of spinal posture. Proc R Soc Med. 1976;69(3):177–8. PMID:1265009, PMCID: PMC1864150.
Millner PA, Dickson RA. Idiopathic scoliosis: biomechanics and biology. Eur Spine J. 1996;5(6):362–73.
Stokes IA, Burwell RG, Dangerfield PH. IBSE. Biomechanical spinal growth modulation and progressive adolescent scoliosis—a test of the ‘vicious cycle’ pathogenetic hypothesis: summary of an electronic focus group debate of the IBSE. Scoliosis. 2006;18(1):16.
Wolff J. The Law of Bone Remodelling. In: Maquet P, Furlong R, editors. Berlin: Springer-Verlag; 1986.
Wolff J. The Classic. Concerning the interrelationship between form and function of the individual parts of the organism. Clin Orthop. 1988;228:2–11.
Golding JSR. The mechanical factors which influence bone growth. Eur J Clin Nutr. 1994;48 Suppl 1:S178–85.
Mau H. Specifizierung der korrespondierenden Wachstums-Gesetze von Hueter-Volkmann und Pauwels (Wachstumde-formitäten) und ihre Beziehung zu den Belasungsde-förmitäten. Z Orthop. 1984;122:293–8.
Grivas TB, Burwell RG, Kechagias V, Mazioti C, Fundas A, Kolovou D, Christodoulou E. Idiopathic and normal lateral lumbar curves: muscle effects interpreted by 12th rib length asymmetry with pathomechanic implications for lumbar idiopathic scoliosis. Eur Spine J. 2015;24(11): 2614–707.
https://musculoskeletalkey.com/thoracic-and-costovertebral-subluxation-syndromes/
Inflammatory disease of the costotransverse joints: US evaluation in 15 symptomatic patients A. Del Chiaro, B. Ciampi, F. Franzoni, M. Miccoli, S. Galletti & S. M. Stella, Journal of Ultrasound volume 25, pages 167–175 (2022)
Musculoskeletal Sports and Spine Disorders pp 369–371 Costovertebral Pain Syndromes, Stephen Erosa DO, Samantha C. Erosa MSIV & Kevin Sperber MD , Chapter First Online: 09 February 2018)
Erosa, S., Erosa, S.C., Sperber, K. (2017). Costovertebral Pain Syndromes. In: Kahn, S., Xu, R. (eds) Musculoskeletal Sports and Spine Disorders. Springer, Cham. doi.org/10.1007/978-3-319-50512-1_84
Gray.H,Gray's anatomy 20th edition.
Radiopedia Costrovert. Joint Available from:https://radiopaedia.org/articles/costovertebral-joint (last accessed 10.5.2020).
B A Young, H E Gill, R S Wainner, T W Flynn. Thoracic costotransverse joint pain patterns: a study in normal volunteers. BMC Musculoskelet disord. 2008; 9: 140 .
Mennen AHM, et al. BMJ Case Rep 2020;13:e234931. doi:10.1136/bcr-2020-234931
Edgecombe L, Angus LD. Thoracic trauma, in StatPearls. Treasure Island (FL, 2018.
Bixby SD, Abo A, Kleinman PK. High-Impact trauma causing multiple posteromedial rib fractures in a child. Pediatr Emerg Care 2011;27:218–9.
Saker E, Graham RA, Nicholas R, et al. Ligaments of the Costovertebral joints including biomechanics, Innervations, and clinical applications: a comprehensive review with application to approaches to the thoracic spine. Cureus 2016;8:e874. 5
Christensen EE, Dietz GW. Injuries of the first costovertebral articulation. Radiology1980;134:41–3.
Schnake KJ, Schroeder GD, Vaccaro AR, et al. AOSpine classification systems (subaxial,thoracolumbar). J Orthop Trauma 2017;31:S14–23.
Hosea TM, Hannafin JA. Rowing injuries. Sports Health 2012;4:236–45.
Low S, Kern M, Atanda A. First-rib stress fracture in two adolescent swimmers: a case report. J Sports Sci 2016;34:1266–70.
Kraan GA, Hoogland PVJM, Wuisman PIJM. Extraforaminal ligament attachments of the thoracic spinal nerves in humans. Eur Spine J 2009;18:490–8.
Speigner B, Verborgt O, Declercq G, et al. Medial scapular winging following trauma-a case report. Acta Orthop 2016;87:203–4.
Mansha M, Middleton A, Rangan A. An unusual cause of scapular winging following trauma in an army personnel. J Shoulder Elbow Surg 2010;19:e24–7.
Morell DJ, Thyagarajan DS. Sternoclavicular joint dislocation and its management: a review of the literature. World J Orthop 2016;7:244–50.
O’Brien SD, Bui-Mansfield LT. Costovertebral fracture dislocations: important radiographically difficult diagnosis. J Comput Assist Tomogr 2009;33:748–51.
Park H-S, Ryu S-M, Cho S-J, et al. A treatment case of delayed aortic injury: the patient with posterior rib fracture. Korean J Thorac Cardiovasc Surg 2014;47:406–8.
Ashrafian H, Kumar P, Sarkar PK, et al. Delayed penetrating intrathoracic injury from multiple rib fractures. J Trauma 2005;58:858–9.
Bruno VD, Batchelor TJP. Late aortic injury: a rare complication of a posterior rib fracture. Ann Thorac Surg 2009;87:301–3.
Iyoda A, Satoh N, Yamakawa H, et al. Rupture of the descending thoracic aorta caused by blunt chest trauma: report of a case. Surg Today 2003;33:755–7.
Kabiri EH, Arsalane A, Zidane A, et al. Atypical traumatic thoracic aorta after rib fractures. Asian Cardiovasc Thorac Ann 2007;15:180–1.
Bartscherer A, Stolarski AE, Miller CP, et al. Costotransverse screws in repair of paraspinal rib fractures-a novel approach for rib fractures threatening the aorta. J Thorac Dis 2019;11:S1090–5.
Grzonkowska M, Baumgart M, Badura M, Dombek M, Wiśniewski M, Paruszewska-Achtel M, Szpinda M. .Quantitative anatomy of the growing quadratus lumborum in the human foetus. Surg Radiol Anat. 2018 Jan;40(1):91-98. [PMC free article: PMC5820394] [PubMed: 28756538] .
Phillips S, Mercer S, Bogduk N. Anatomy and biomechanics of quadratus lumborum. Proc Inst Mech Eng H. 2008 Feb;222(2):151-9. [PubMed: 18441751].
Chal J, Pourquié O. Making muscle: skeletal myogenesis in vivo and in vitro. Development. 2017 Jun 15;144(12):2104-2122. [PubMed: 28634270] .
Hernández-Hernández JM, García-González EG, Brun CE, Rudnicki MA. The myogenic regulatory factors, determinants of muscle development, cell identity and regeneration. Semin Cell Dev Biol. 2017 Dec;72:10-18. [PMC free article: PMC5723221] [PubMed: 29127045] .
Beveridge TS, Power A, Johnson M, Power NE, Allman BL. The lumbar arteries and veins: Quantification of variable anatomical positioning with application to retroperitoneal surgery. Clin Anat. 2015 Jul;28(5):649-60. [PubMed: 25644404] .
Singh T, Andi K. Iliolumbar artery: a useful pedicle for the iliac crest free flap in maxillofacial reconstruction. Br J Oral Maxillofac Surg. 2017 Apr;55(3):270-273. [PubMed: 28089170] .
Beveridge TS, Allman BL, Johnson M, Power A, Sheinfeld J, Power NE. Retroperitoneal Lymph Node Dissection: Anatomical and Technical Considerations from a Cadaveric Study. J Urol. 2016 Dec;196(6):1764- 1771. [PMC free article: PMC5412119] [PubMed: 27389330] .
Kim JH, Won HS, Chung IH, Kim IB. The enigmatic subcostal muscle: Anatomical study with application to spine and chest pain syndromes and avoidance of confusion on imaging. Clin Anat. 2015 Nov;28(8):1017-21. [PubMed: 26384842].
Ueshima H, Otake H, Lin JA. Ultrasound-Guided Quadratus Lumborum Block: An Updated Review of Anatomy and Techniques. Biomed Res Int. 2017;2017:2752876. [PMC free article: PMC5244003] [PubMed: 28154824] .
Tulgar S, Ermis MN, Ozer Z. Combination of lumbar erector spinae plane block and transmuscular quadratus lumborum block for surgical anaesthesia in hemiarthroplasty for femoral neck fracture. Indian J Anaesth. 2018 Oct;62(10):802-805. [PMC free article: PMC6190427] [PubMed: 30443064] .
Adhikary SD, Short AJ, El-Boghdadly K, Abdelmalak MJ, Chin KJ. Transmuscular quadratus lumborum versus lumbar plexus block for total hip arthroplasty: A retrospective propensity score matched cohort study. J Anaesthesiol Clin Pharmacol. 2018 Jul-Sep;34(3):372-378. [PMC free article: PMC6194838] [PubMed: 30386022].
Sions JM, Elliott JM, Pohlig RT, Hicks GE. Trunk Muscle Characteristics of the Multifidi, Erector Spinae, Psoas, and Quadratus Lumborum in Older Adults With and Without Chronic Low Back Pain. J Orthop Sports Phys Ther. 2017 Mar;47(3):173-179. [PMC free article: PMC7064314] [PubMed: 28158957].
Aboufazeli M, Akbari M, Jamshidi AA, Jafarpisheh MS. Comparison of Selective Local and Global Muscle Thicknesses in Females with and without Chronic Low Back Pain. Ortop Traumatol Rehabil. 2018 Jun 27;20(3):197-204. [PubMed: 30152768].
Ranger TA, Cicuttini FM, Jensen TS, Peiris WL, Hussain SM, Fairley J, Urquhart DM. Are the size and composition of the paraspinal muscles associated with low back pain? A systematic review. Spine J. 2017 Nov;17(11):1729-1748. [PubMed: 28756299].
Hong JO, Park JS, Jeon DG, Yoon WH, Park JH. Extracorporeal Shock Wave Therapy Versus Trigger Point Injection in the Treatment of Myofascial Pain Syndrome in the Quadratus Lumborum. Ann Rehabil Med. 2017 Aug;41(4):582-588. [PMC free article: PMC5608665] [PubMed: 28971042] .
Alport B, Horne D, Burbridge B. Heterotopic ossification of the quadratus lumborum muscle. J Radiol Case Rep. 2014 Jan;8(1):41-6. [PMC free article: PMC4037244] [PubMed: 24967013.] .
Tozzi P, Bongiorno D, Vitturini C. Fascial release effects on patients with non-specific cervical or lumbar pain. J Bodyw Mov Ther. 2011 Oct;15(4):405-16. [PubMed: 21943614].
Zarei H, Bervis S, Piroozi S, Motealleh A. Added Value of Gluteus Medius and Quadratus Lumborum Dry Needling in Improving Knee Pain and Function in Female Athletes With Patellofemoral Pain Syndrome: A Randomized Clinical Trial. Arch Phys Med Rehabil. 2020 Feb;101(2):265-274. [PubMed: 31465756] .
Lilly Su a, Alicia Greene b, Anthony Tsai c, Almost slipped through the crack: Pediatric patient with bilateral slipped rib syndrome and twelfth rib syndrome of the eleventh ribs doi.org/10.1016/j.epsc.2022.102408 Received 22 July 2022; Accepted 30 July 2022 Journal of Pediatric Surgery Case Reports 85 (2022) 102408
Pain Physician 2020; 23:E45-E50 • ISSN 2150-1149 Treatment and Management of Twelfth Rib
Syndrome: A Best Practices Comprehensive Review
Gress K, Charipova K, Kassem H, et al. A comprehensive review of slipping rib syndrome: treatment and management. Psychopharmacol Bull 10 15 2020;50(4 Suppl 1):189–96.
McMahon L.E. Slipping Rib Syndrome: a review of evaluation, diagnosis and treatment. Semin Pediatr Surg Jun 2018;27(3):183–8. doi.org/10.1053/ j.sempedsurg.2018.05.009.
Khan N.A.J, Waseem S, Ullah S, Mehmood H. Slipping rib syndrome in a female adult with longstanding intractable upper abdominal pain. Case Rep Med 2018; 2018:7484560 doi.org/10.1155/2018/7484560.
Urits I, Noor N, Fackler N, et al. Treatment and management of twelfth rib syndrome: a best practices comprehensive review. Pain Physician 01 2021;24(1): E45–50.
Heinz G.J, Zavala D.C. Slipping rib syndrome. JAMA Feb 21 1977;237(8):794–5.
Van Tassel D, McMahon L.E, Riemann M, Wong K, Barnes C.E. Dynamic ultrasound in the evaluation of patients with suspected slipping rib syndrome. Skeletal Radiol May 2019;48(5):741–51. doi.org/10.1007/s00256-018-3133-z.
Fares M.Y, Dimassi Z, Baydoun H, Musharrafieh U. Slipping rib syndrome: solving the mystery of the shooting pain. Am J Med Sci. 02 2019;357(2):168–73. doi.org/10.1016/j.amjms.2018.10.007.
Cranfield K.A, Buist R.J, Nandi P.R, Baranowski A.P. The twelfth rib syndrome. J Pain Symptom Manag Mar 1997;13(3):172–5. doi.org/10.1016/s0885- 3924(96)00271-0.
Hansen A.J, Toker A, Hayanga J, Buenaventura P, Spear C, Abbas G. Minimally invasive repair of adult slipped rib syndrome without costal cartilage excision. Ann Thorac Surg Sep 2020;110(3):1030–5. doi.org/10.1016/j.athoracsur.2020.02.081.
Machin DG, Shennan JM. Twelfth rib syndrome: A differential diagnosis of loin pain. Br Med J 1983; 287:586.
Cranfield KAW, Buist RJ, Nandi PR, Baranowski AP. The twelfth rib syndrome. J Pain Symptom Manage 1997; 13:172-175.
Keoghane SR, Douglas J, Pounder D. Twelfth rib syndrome: A forgotten cause of flank pain. BJU Int 2009; 103:569-570.
Germanovich A, Ferrante FM. Multimodal treatment approach to painful rib syndrome: Case series and review of the literature. Pain Physician 2016; 19:E465-E471.
Khan NAJ, Waseem S, Ullah S, Mehmood H. Slipping rib syndrome in a female adult with longstanding intractable upper abdominal pain. Case Rep Med 2018; 2018:3-6.
Migliore M, Signorelli M, Caltabiano R, Aguglia E. Flank pain caused by slipping rib syndrome. Lancet 2014; 383:844.
Scott BB, Scott EM. Painful rib syndrome: A review of 76 cases. Gut1993; 34:1006-1008.
Turcios NL. Slipping rib syndrome: An elusive diagnosis. Paediatr Respir Rev 2017; 22:44-46.
Fam AG, Smythe HA. Musculoskeletal chest wall pain. CMAJ 1985; 133:379-389.
Vadhanan P, Hussain M, Prakash R. The subcostal nerve as the target for nerve stimulator guided transverse abdominis plane blocks: A feasibility study. Indian J Anaesth 2019; 63:265-269.
Jalovaara P, Rämö J, Lindholm R. Twelfth-rib syndrome simulating intra-abdominal disease. Case report. Acta Chir Scand. 1988;154:407-408.
Udermann BE, Cavanaugh DG,Gibson MH, Doberstein ST, Mayer JM, Murray SR. Slipping rib syndrome in a collegiate swimmer: A case report. J Athl Train 2005; 40:120-122.
Kumar R, Ganghi R, Rana V, Bose M.The painful rib syndrome. Indian J Anaesth 2013; 57:311-313.
Bonica JJ. The management of pain: The future. In: Stanley TH, Ashburn MA,
Fine PG (eds). Anesthesiology and Pain Management. Developments in Critical Care Medicine and Anesthesiology. Vol24. Dordrecht, Springer, 1991: pp.73-92.
Wells JCD. Twelfth rib syndrome. Br Med J 1983; 287:1725.
Wynne A, Nelson M, Nordin B. Costoiliac impingement syndrome. J Bone JtSurg Br. 1985; 67:124-125.
Cranfield KA, Buist RJ, Nandi PR, Baranowski AP. The twelfth rib syndrome. Journal of Pain and Symptom Management. 1997;13:172-5.
Spence EK, Rosato EF. The slipping rib syndrome Arch Surg. 1983;118:1330-2.
Gillian A. Hawker, Samra Mian, Tetyana Kendzerska, Melissa French. Measures of adult pain. Arthritis Care & Research. 2011;63:240-52.
Heinz GJ, Zavala DC. Slipping rib syndrome Diagnosis using the hooking maneuvers. JAMA. 1977;237:794-5.
Cyriax EF. On various conditions that may simulate the referred pains of visceral disease, and a consideration of these from the point of view of cause and effect. Practitioner. 1919;102:314-9.
Scott EM, Scott BB. Painful rib syndrome. Gut.1993;34:1006-8.
Machin DG, Shennan JM. Twelfth rib syndrome: a differential diagnosis of loin pain. Br Med J (Clin Res Ed). 1983;287:586.
Roaf R. 1958 Rotation movements of the spine with special reference to scoliosis. J Bone Joint Surg Br. 1958;40-B(2):312–32.
Riddle HFV, Roaf R. Muscle imbalance in the causation of scoliosis. Lancet, 1. 1955;268(6877):1245–7. PMID:14382561.
Fidler MW, Jowett RL, Troup JDG. Histochemical study of the function of multifidus in scoliosis. In: Zorab PA, editor. Scoliosis and Muscle. London: William Heinemann Medical Books Ltd; 1974. p. 184–92.
Fidler MW, Jowett RL. Muscle imbalance in the aetiology of scoliosis. J Bone Joint Surg Br. 1976;58(2):200–1.
Zuk T. The role of spinal and abdominal muscles in the pathogenesis of scoliosis. Journal of Bone and Joint Surgery. 1962;44-B:102–5.
Schmitt O. Electrical Stimulation of intercostal muscles in idiopathic scoliosis. Proceedings of the Third Meeting of ISAO, Motor Prosthesis and Bone Stimulation, Artificial Organs. 1981;5(Suppl):589–93.
Roaf R. The intercostal muscles and conditioned reflexes in the control of spinal posture. Proc R Soc Med. 1976;69(3):177–8. PMID:1265009, PMCID: PMC1864150.
Millner PA, Dickson RA. Idiopathic scoliosis: biomechanics and biology. Eur Spine J. 1996;5(6):362–73.
Stokes IA, Burwell RG, Dangerfield PH. IBSE. Biomechanical spinal growth modulation and progressive adolescent scoliosis—a test of the ‘vicious cycle’ pathogenetic hypothesis: summary of an electronic focus group debate of the IBSE. Scoliosis. 2006;18(1):16.
Wolff J. The Law of Bone Remodelling. In: Maquet P, Furlong R, editors. Berlin: Springer-Verlag; 1986.
Wolff J. The Classic. Concerning the interrelationship between form and function of the individual parts of the organism. Clin Orthop. 1988;228:2–11.
Golding JSR. The mechanical factors which influence bone growth. Eur J Clin Nutr. 1994;48 Suppl 1:S178–85.
Mau H. Specifizierung der korrespondierenden Wachstums-Gesetze von Hueter-Volkmann und Pauwels (Wachstumde-formitäten) und ihre Beziehung zu den Belasungsde-förmitäten. Z Orthop. 1984;122:293–8.
Grivas TB, Burwell RG, Kechagias V, Mazioti C, Fundas A, Kolovou D, Christodoulou E. Idiopathic and normal lateral lumbar curves: muscle effects interpreted by 12th rib length asymmetry with pathomechanic implications for lumbar idiopathic scoliosis. Eur Spine J. 2015;24(11): 2614–707.
Irwin J. et al, The effect of costovertebral adjustment versus ischaemic compression of rhomboid muscles for interscapular pain, university of johannesburg, 2015

SLIPPING RIB SYNDROME RESOURCES & STUDIES