Recurrent Pain after Resection for Slipping Rib Syndrome: Report of a Difficult Case

Slipping rib syndrome, first described in 1919, is thought to be caused by increased mobility of the anterior ends of costal cartilages, enabling them to slip around and compress intercostal nerves, leading to inflammation and pain.1 Although cases affecting ribs three through 11 have been reported, false ribs, eight through 10, are most commonly affected because of their intrinsically increased mobility, indirect attachment to the sternum, and greater susceptibility to trauma.2 Patients often report popping or clicking sensations with certain movements due to dislocation of affected costal cartilages.3 Although it has been over a century since this condition was first described, the exact pathophysiology has yet to be determined, and SRS is rarely referenced in surgical textbooks. The general lack of awareness of SRS has caused several patients to withstand months or even years of unresolved pain before being diagnosed.1 The hooking maneuver was established in 1977 as the gold standard for diagnosis. If this motion is able to reproduce the patient's pain, the hooking maneuver is positive and provides sufficient evidence to give a diagnosis of SRS.1 Conservative treatments have provided temporary relief for many patients, but surgical resection of affected cartilages is the only treatment to date that has shown a definitive resolution of pain.2 In our case, the patient's pain has yet to be completely resolved, and there is still an ongoing struggle for a complete resolution, as true for other patients with SRS.3 The purpose of this case report is to spread knowledge and awareness of this rare pain syndrome and provide a detailed investigation of a young teenager suffering from SRS.