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Diagnosis and Treatment of Slipping Rib Syndrome

Journal: Clinical Journal of Sport Medicine Date: 2019/01, 29(1):Pages: 18-23. doi: Subito , type of study: clinical trial

Full text    (https://insights.ovid.com/crossref?an=00042752-201901000-00004)

Keywords:

athlete [22]
rib pain [2]
slipping rib syndrome [1]
subluxing rib [1]
sports medicine [9]
adolescent [52]
pediatric [452]
child [312]
Tietze syndrome [1]
OMT [2951]
osteopathic manipulative treatment [2973]
clinical trial [612]

Abstract:

Objective:: (1) To investigate the clinical presentation, diagnosis, and treatment of slipping rib syndrome in athletes; (2) to investigate the hooking maneuver for diagnosis of slipping rib syndrome.Design:Retrospective chart review of 362 athletes with rib pain.Setting:Pediatric-based sports medicine clinic between January 1, 1999, and March 1, 2014.Patients:Costochondritis, Tietze, fractures, rib tip syndrome, and unclear diagnoses were excluded. Athletes were included who had a palpable rib subluxation, mechanical rib symptom, positive hooking maneuver, or resolution of pain after the resection of a slipping rib segment.Main Outcome Measures:Slipping rib syndrome is associated with athletic performance.Results:Fifty-four athletes were diagnosed with slipping rib syndrome, of which 38 (70%) were females. Mean age at presentation was 19.1 years (range 4-40 years). Mean number of previous specialist consultations per athlete was 2.3 and mean time from symptom onset to diagnosis was 15.4 months. The hooking maneuver was attempted 21 times (38.9%). Unilateral symptoms presented in 49 athletes (90.7%). The most symptomatic rib was the 10th, affecting 24 athletes (44.4%), eighth and ninth were affected in 17 athletes (31.5%) each. Most, 39 (72.2%), reported insidious onset of symptoms. Running, rowing, lacrosse, and field hockey were frequently associated activities. Twelve athletes had psychiatric diagnoses (22.2%), 10 (19.2%) were hypermobile. Sixty-six total imaging studies were performed. The most successful treatment options included: osteopathic manipulative treatment (71.4%), surgical resection (70%), and diclofenac gel (60%).Conclusions:Most athletes with slipping rib syndrome were active females with insidious onset of unilateral pain, a high prevalence of hypermobility and prolonged pain. The hooking maneuver was underused.


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