Slipping rib syndrome
Initial management included over-the-counter NSAIDS, osteopathic manipulation as needed, and physical therapy focused on improving posture, core strength, and neuromuscular retraining, with which she had been non-compliant. Upon her return, conservative care was re-initiated (16 weeks total) with some improvement. The athlete was still unable to compete due to her symptoms, so an intercostal rib block was performed under ultrasound guidance at the single level thought to be the source of most pain. Case Photo #1
The patient achieved 100% relief for 2 weeks. At 4 weeks, the pain was 30-50% better at the injected level, but the other levels remained painful. Other treatment options, including platelet-rich plasma therapy, prolotherapy, and surgery, were discussed with the family. They requested additional intercostal blocks at other levels to see if a cumulative effect was enough for pain-free competition.
After her injections, the patient returned to dancing with no restrictions, but she continues to have intermittent mild pain. At this time, she is satisfied with her results and wants to abstain from further injections.
The patient is currently stable and performing all activities without restriction. If symptoms begin to worsen, the patient and her guardian would like a trial of prolotherapy.
Slipping rib syndrome is an uncommon condition, and it can occur in athletes of all ages. Rib hypermobility can lead to irritation and inflammation of the intercostal nerves, muscles and costal cartilage. Slipping rib syndrome usually occurs at ribs 8,9, or 10. It is usually unilateral, but it can be bilateral as in this case. If conservative therapy fails, surgery may be considered.
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