# Slipping Rib Syndrome — GCMD Library living collection Everything in the library about slipping rib syndrome — built automatically from dossiers that name it. Updated: n/a · 3 episodes · 22 cited statements ## Episodes ### Surgical Management - [Update Course Rewind: Part 2 Non-Pectus Uses of Cryoanalgesia 2024](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622) — video · 4:23 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622.md) ### Evidence & Research - [Initial Outcomes Using Cryoablation in Surgical Management of Slipping Rib Syndrome](https://qa.library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndr-7456) — video · 1:03 · [machine version](https://qa.library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndr-7456.md) - [Journal of Pediatric Surgery Article REview: August Issue 2023](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977) — podcast · 17:30 · [machine version](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977.md) ## Chapters - [0:00](https://qa.library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndr-7456?t=0) Cryoablation in Slipping Rib Syndrome Surgery (Ep 1) - [0:00](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=0) Cryoablation in Nuss Procedures: Evolution of Hospital Length of Stay and Opioid Use (Ep 2) - [5:07](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=307) Management of Primary Spontaneous Pneumothorax in Children (Ep 2) - [8:23](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=503) Updated APSA Guidelines for Solid Organ Injury Management (Ep 2) - [11:16](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=676) Cryoablation in Surgical Management of Slipping Rib Syndrome (Ep 2) - [0:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=0) Introduction and Series Context (Ep 3) - [0:56](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=56) Percutaneous Cryotherapy Approaches (Ep 3) - [1:21](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=81) Slipping Rib Syndrome: Pathophysiology and Presentation (Ep 3) - [2:12](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=132) Treatment Algorithm for Slipping Rib Syndrome (Ep 3) - [2:56](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=176) Cryoablation Outcomes in Slipping Rib Syndrome (Ep 3) - [3:23](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=203) Case: Cryoablation for Rib Fractures (Ep 3) - [3:49](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=229) Summary and Tool Adaptation (Ep 3) ## Statements Every statement is attributed, typed, and timestamped; the link is the citation. - Interventional radiology has percutaneous needle options available for cryotherapy beyond the standard cryoprobe. (clinical) [Ep 3 · 1:04](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=64) - Cryoablation has shown real benefits for rib fractures, slipping rib syndrome, and other endochondromas. — Thomas Inge (clinical) [Ep 3 · 1:12](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=72) - Laxity in costochondral junctions and impingement on intercostal nerves as the ribs slip and float causes slipping rib syndrome. — Thomas Inge (clinical) [Ep 3 · 1:28](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=88) - Slipping rib syndrome can be the cause of chronic abdominal wall pain. — Thomas Inge (clinical) [Ep 3 · 1:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=90) - Patients with slipping rib syndrome may have already had their appendix or gallbladder removed before arriving at the correct diagnosis. — Thomas Inge (clinical) [Ep 3 · 1:44](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=104) - Patients with slipping rib syndrome often undergo multiple colonoscopies, CTs, and ultrasounds before diagnosis. — Thomas Inge (clinical) [Ep 3 · 1:51](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=111) - The usual approach for patients with slipping rib syndrome is to refer them to chronic pain for evaluation and intercostal block with steroid and long-acting local anesthetic. — Thomas Inge (clinical) [Ep 3 · 2:12](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=132) - If there's a response to intercostal block, the next step is to refer to surgery. — Thomas Inge (clinical) [Ep 3 · 2:34](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=154) - Interventional radiology performs cryoablation using needle probes at single or multiple levels for slipping rib syndrome. — Thomas Inge (clinical) [Ep 3 · 2:38](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=158) - Cryoablation can be used intraoperatively in combination with surgery to remove rib tips or stabilize a slipping cartilaginous costal margin. — Thomas Inge (clinical) [Ep 3 · 3:01](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=181) - For patients with chest rib fractures who get stuck on a ventilator, cryoablation can do a world of good by anesthetizing the intercostal spaces that are the problem. — Thomas Inge (clinical) [Ep 3 · 3:27](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=207) - Interventional radiology colleagues use the same needles for cryoablating liver lesions and lung nodules that can be applied to intercostal nerve cryoablation. (clinical) [Ep 3 · 3:55](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=235) - Phoenix Children's Hospital study compared first quarter versus fourth quarter of cryoablation experience in Nuss procedures, finding 74% less opioid use and 80% of patients achieving early discharge home by postoperative day 2 in the fourth quarter. — DeFiore (clinical) [Ep 2 · 2:26](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=146) - In 59 pediatric primary spontaneous pneumothorax patients, aspiration was successful in 33% while 66% still required VATS. — Shawn St. Peter (clinical) [Ep 2 · 6:15](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=375) - Median length of stay with successful aspiration for primary spontaneous pneumothorax was 20 hours (less than a day), while median length of stay after VATS was 3 days. — Shawn St. Peter (clinical) [Ep 2 · 6:15](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=375) - The entire treatment algorithm for spontaneous pneumothorax depends on whether the patient had a bleb that popped (requiring only aspiration) or has an ongoing lung leak (requiring operation). — Shawn St. Peter (clinical) [Ep 2 · 7:38](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=458) - The most important change in updated APSA guidelines is that discharge of solid organ injury patients is not related to severity of injury but to clinical condition of the patient. — Regan Williams (guideline) [Ep 2 · 9:34](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=574) - Over 22-23 years, solid organ injury management has been refined so patients don't need to be in hospital as long or on bed rest as long, with management now based on hemodynamic status rather than grade of injury. — Whit Holcomb (clinical) [Ep 2 · 10:19](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=619) - Decision making for solid organ injury should be based on clinical symptoms and signs of ongoing bleeding rather than solely on grade of injury from imaging, though injury grade provides information about bleeding likelihood. — Regan Williams (clinical) [Ep 2 · 10:48](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=648) - Extrathoracic cryoablation technique for slipping rib syndrome involves placing the probe laterally to the plate location on the ribs through the incision used for rib removal. — Lisa McMahon (clinical) [Ep 2 · 12:49](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=769) - Visual analog scale pain scores were similar across all slipping rib syndrome groups, but opioid requirement was significantly less in the slipping rib plus cryoablation group compared to slipping rib without cryoablation group. — Crystal Lai (clinical) [Ep 2 · 13:57](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=837) - Abdominal wall laxity after T9 and T10 cryoablation was seen only once, in a pectus patient rather than a slipping rib patient. — Lisa McMahon (clinical) [Ep 2 · 14:27](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=867) ## Host summaries Recaps by a host of what the experts said — not the host's own clinical position. - The study was a retrospective review conducted in Phoenix between 2018 and 2022 — Cecilia Gigena summarizing a resource [Ep 1 · 0:11](https://qa.library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndr-7456?t=11) - The study compared length of stay and opiate use in patients undergoing cartilaginous rib excision with and without cryo — Cecilia Gigena summarizing a resource [Ep 1 · 0:16](https://qa.library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndr-7456?t=16) - The study included 98 patients total — Cecilia Gigena summarizing a resource [Ep 1 · 0:27](https://qa.library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndr-7456?t=27) - 68 patients underwent resection without cryo — Cecilia Gigena summarizing a resource [Ep 1 · 0:27](https://qa.library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndr-7456?t=27) - 22 patients underwent resection with cryo — Cecilia Gigena summarizing a resource [Ep 1 · 0:27](https://qa.library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndr-7456?t=27) - 8 patients underwent a NAS procedure plus cartilaginous resection with cryoalgesia — Cecilia Gigena summarizing a resource [Ep 1 · 0:27](https://qa.library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndr-7456?t=27) - Patients who underwent resection with cryo had significantly less opiate use — Cecilia Gigena summarizing a resource [Ep 1 · 0:43](https://qa.library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndr-7456?t=43) - Patients who underwent resection with cryo stayed one day less than patients without cryo, though this difference was not statistically significant — Cecilia Gigena summarizing a resource [Ep 1 · 0:43](https://qa.library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndr-7456?t=43) - Cryoablation is not limited to thoracotomy or thoracoscopy; there are novel ways to use cryotherapy in a percutaneous approach. — Lizzy Lee summarizing the discussion [Ep 3 · 0:56](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=56) - Slipping rib syndrome is a condition with cartilaginous union at the end of the ribs, particularly for floating ribs but also for false ribs. — Lizzy Lee summarizing the discussion [Ep 3 · 1:21](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=81) - Slipping rib syndrome is more common in teenage girls than boys. — Lizzy Lee summarizing the discussion [Ep 3 · 1:58](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=118) - Patients with slipping rib syndrome often present with somatic tenderness of the abdominal wall that can be elicited by asking them to flex or crunch their abdominal muscles, but they really won't have a visceral type tenderness. — Lizzy Lee summarizing the discussion [Ep 3 · 2:01](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=121) - If patients get pain relief from the intercostal block with ropivacaine and dexamethasone, the next step is to refer them to interventional radiology for ultrasound-guided cryotherapy. — Lizzy Lee summarizing the discussion [Ep 3 · 2:25](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=145) - Outcomes from using cryoablation for slipping rib syndrome included reduced pain scores, reduced narcotic use, and shorter length of stay in the hospital. — Lizzy Lee summarizing the discussion [Ep 3 · 3:13](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=193) - Patients treated with cryoablation for slipping rib syndrome were able to resume normal activities much earlier. — Lizzy Lee summarizing the discussion [Ep 3 · 3:19](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=199) - Reduced opioid use and shorter length of stay in Nuss procedures was primarily related to discontinuing use of IV PCA during the study period, based on observation that patients weren't using the IV PCA. — Cecilia Gigena summarizing the discussion [Ep 2 · 2:46](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=166) - IV PCA does not appear necessary in Nuss procedures with cryoablation and can be eliminated fairly early in a surgeon's experience. — Cecilia Gigena summarizing the discussion [Ep 2 · 2:46](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=166) - The learning curve for cryoablation in Nuss procedures is not about surgical technique but about pain protocols, with earlier differences due to comfort level with discontinuing PCA and switching to oral pain medication rather than poor cryoablation technique. — Cecilia Gigena summarizing the discussion [Ep 2 · 4:03](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=243) - Cryoablation implementation requires a protocol or regimen including pain team involvement preoperatively and postoperatively, with adjuncts such as gabapentin, rather than cryoablation alone. — Cecilia Gigena summarizing the discussion [Ep 2 · 4:40](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=280) - Kansas City protocol for primary spontaneous pneumothorax involves small catheter placement mimicking aspiration, clamping, and chest X-ray at 6 hours, with success defined as equal or lower than 2 centimeter distance between chest wall and lung at apex and no air leak when clamp released. — Em Gootee summarizing the discussion [Ep 2 · 5:32](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=332) - Patients going to VATS immediately after failed aspiration had median length of stay of 3.1 days, compared to 6 days median length of stay for patients in the Midwest Pediatric Surgery Consortium. — Cecilia Gigena summarizing the discussion [Ep 2 · 7:02](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=422) - Updated APSA guidelines for solid organ injury use APSA framework: A for admission (identifying ICU risk factors), P for procedures (focusing on angiography, when to operate, transfuse, or use angio suite), S for set free/discharge, and A for aftercare. — Whit Holcomb summarizing the discussion [Ep 2 · 9:21](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=561) - Phoenix Children's slipping rib syndrome study included 98 patients: 68 had rib resection without cryoablation (receiving other blocks like rectus spinae, paravertebral, or intercostal), 22 had extrathoracic cryoablation plus other nerve blocks, and 8 had slipping ribs resected as part of Nuss procedure. — Cecilia Gigena summarizing the discussion [Ep 2 · 11:53](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=713) - 91% of cryoablation patients had cryoablation of T9 and T10 intercostal nerves with no documented abdominal wall laxity at immediate follow-up of 16 days. — Cecilia Gigena summarizing the discussion [Ep 2 · 13:10](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=790) - Patients who underwent rib excision with cryoablation used significantly less opioids in hospital compared to rib excision without cryoablation, with median length of stay of 1 day versus 2 days. — Cecilia Gigena summarizing the discussion [Ep 2 · 13:10](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=790) - Patients with very low pectus deformities may have more discomfort in the lower costal margin area because it extends beyond the T7 and T8 field where most cryoablation is performed. — Cecilia Gigena summarizing the discussion [Ep 2 · 14:46](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=886) --- Educational content from recorded physician discussions — not medical advice. 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