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Slipping Rib Syndrome
Ross Hauser, M.D.
Slipping Rib Syndrome, also
known as
Tietze's Syndrome This disorder was first described in 1921 by Alexander Tietze.,
M.D.
Other names include xiphoidalgia, costochondritis, and
anterior chest-wall syndrome. But, in my opinion, the most descriptive and accurate name for
the condition is Slipping Rib Syndrome.
Why does the rib slip out of place?
In many cases a rib slips out of place because the
ligaments that hold the
ribs to the sternum, the sternocostal ligaments, have been weakend. Without muscles to
hold the ribs in place, weakened ligaments allow slipping of the rib. This in
turn causes
further stretching of the ligament, producing severe
pain.
The loose ribs can also pinch intercostal nerves, sending excruciating
pains around the chest into the back. Sternocostal and costochondral ligaments
refer pain from the front of the chest to the mid back. Likewise,
costovertebral
ligament sprains refer pain from the back of the rib segment to
the sternum where the rib attaches.
Some in medicine believes the condition is caused by
inflammation in the costochondral junction causing costochondritis.
NSAIDS, a non-steroidal
anti-inflammatory
medications is then given.
Chronic pain, no matter what the cause, is not due to a NSAID
deficiency. Slipping Rib Syndrome is caused by weakness of the
sternocostal, costochondral, or costovertebral ligaments.
Prolotherapy will
strengthen these ligament junctions in all the areas where the ribs are
hypermobile.
Slipping Rib Syndrome may be caused by
hypermobility of the anterior end of
the costal
cartilage, located at the rib-cartilage interface called the
costochondral junction. Most often, the tenth rib is the source because,
unlike ribs one through seven which attach to the sternum, the eighth, ninth,
and tenth ribs are attached anteriorly to each other by loose, fibrous tissue.
This provides increased mobility, but a greater susceptibility to trauma.
Slipping rib cartilage may cause no pain or only intermittent pain.
Slipping Rib Syndrome is also more likely to occur in the lower ribs because
of the poor blood supply to the cartilaginous tissue and ligaments. Injury to
the cartilage tissue in the lower ribs or the sternocostal ligaments in the
upper ribs seldom completely heal naturally. The sternocostal, rib-sternum,
and costochondral joints undergo stress when the rib cage expands or contracts
abnormally or when excessive pressure is applied on the ribs themselves.
In order for the rib cage to expand and contract with each breath, the
costochondral and the sternocostal junctions are naturally loose. Humans
breathe 12 times per minute, 720 times per hour, 19,280 times per day, which
stresses these ligamentous-rib junctions. Additional stressors include any
condition that makes breathing more difficult.
A simple coughing attack due to a cold may cause the development of Slipping
Rib Syndrome. Conditions such as bronchitis, emphysema, allergies, and asthma
cause additional stress to the sternocostal and costochondral junctions. Even
sinusitis, with the associated nose blowing can be the initial event t hat
leads to chronic chest pain from Slipping Rib Syndrome.
Other causes of Slipping Rib Syndrome include "fall asleep in
the back seat of a crowded car syndrome." A person falls asleep in a
crowded car with the door handle jutting into a rib. The rib slips out of
place and the problem begins. Another cause of Slipping Rib Syndrome is the
result of surgery to the lungs, chest, heart, or breast with resection of the
lymph nodes which puts a tremendous stress on the rib attachments because the
surgeon must separate the ribs to remove the injured tissue. Unresolved chest
or upper
back pain following a thoracotomy, chest operation, or CPR is most
likely due to
ligament laxity in the rib-sternum or the rib-vertebral
junction.
The ribs are attached in the front, as well as in the back of the body. A
loose rib in the front is likely also loose in the back. The rib-vertebral
junction is known as the costovertebral junction, and is secured by the
costotransverse ligaments.
Unexplained upper back pain, between the shoulder blades and costovertebral,
rib-vertebrae pain, is likely due to joint laxity and/or weakness in the
costotransverse ligaments. (Chronic chest pain, especially in young people, is
often due to weakness in the sternocostal and costochondral junctions, and
chronic mid-upper back pain is due to weakness at the costovertebral
junction.
Both conditions may lead to Slipping Rib Syndrome where the rib intermittently
slips out of place, causing a stretching of the ligamentous support of the rib
in the front and back. The result is periodic episodes of severe pain and
underlying chronic chest and/or upper back pain. Prolotherapy, by
strengthening these areas, provides definitive results in the relief of the
chronic chest pain or chronic upper back pain from Slipping Rib Syndrome.
Costovertebral
ligament injuries
Costovertebral ligament laxity often refers pain from the mid-upper back to
the chest. This is one of the causes for chronic chest discomfort.
Costovertebral ligament injuries are very slow to heal, or heal incompletely,
because they are constantly under stress from the movement of the rib cage
during breathing. The costovertebral junctions are prone to being injured any
time the rib cage is jarred. This may occur from being hit in the chest, after
receiving CPR, or from the effects of heart or
thoracic surgery. During these
types of surgeries, the sternum is opened and the ribs are spread apart,
commonly causing injury to the costovertebral junctions. Chronic chest or
upper-back discomfort after heart or lung surgery is almost always due to
injury to the ligament support at the rib attachments in the thoracic spine or
on the sternum. Prolotherapy is extremely effective at eliminating discomfort
of the chest and upper back following surgical procedures such as cardiac-
bypass.
More on
Slipping
Rib Syndrome
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