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Slipping Rib Syndrome
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Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
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, Update Course Rewind: Part 2 Non-Pectus Uses of Cryoanalgesia 2024 · 2:12
Update Course Rewind: Part 2 Non-Pectus Uses of Cryoanalgesia 2024
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In this insightful recap from the 12th Annual Update Course in Pediatric Surgery, Dr. Thomas Inge of Lurie Children’s Hospital explores emerging uses of cryoanalgesia beyond pectus repair. The video delves into novel applications of cryothe
video4:23 · Jun 2025
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, Journal of Pediatric Surgery Article REview: August Issue 2023 · 9:34
Initial Outcomes Using Cryoablation in Surgical Management of Slipping Rib Syndrome
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Another article from the Journal of Pediatric Surgery by Dr. Cecilia Gigena
"Initial Outcomes Using Cryoablation in Surgical Management of Slipping Rib Syndrome"
Authors: Krista Lai, R Scott Eldredge, Melissa Nguyen, Benjamin E. Padilla,
video1:03 · Oct 2023
Journal of Pediatric Surgery Article REview: August Issue 2023
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We’re featuring Journal of Pediatric surgery articles to bring you some of the latest news!
This week we are discussing 4 articles from August 2023 issue, with editor Dr. Holcomb, the expert Dr. Di Fiore and authors Drs. Krista Lai, Rega
podcast17:30 · Feb 2024
Expert statements from the recordings in this collection.
Initial Outcomes Using Cryoablation in Surgical Management of Slipping Rib Syndrome
The study was a retrospective review conducted in Phoenix between 2018 and 2022
The study compared length of stay and opiate use in patients undergoing cartilaginous rib excision with and without cryo
The study included 98 patients total
68 patients underwent resection without cryo
22 patients underwent resection with cryo
8 patients underwent a NAS procedure plus cartilaginous resection with cryoalgesia
Patients who underwent resection with cryo had significantly less opiate use
Patients who underwent resection with cryo stayed one day less than patients without cryo, though this difference was not statistically significant
Update Course Rewind: Part 2 Non-Pectus Uses of Cryoanalgesia 2024
Cryoablation is not limited to thoracotomy or thoracoscopy; there are novel ways to use cryotherapy in a percutaneous approach.
Interventional radiology has percutaneous needle options available for cryotherapy beyond the standard cryoprobe.
Cryoablation has shown real benefits for rib fractures, slipping rib syndrome, and other endochondromas.
Thomas Inge1:12
Slipping rib syndrome is a condition with cartilaginous union at the end of the ribs, particularly for floating ribs but also for false ribs.
Laxity in costochondral junctions and impingement on intercostal nerves as the ribs slip and float causes slipping rib syndrome.
Thomas Inge1:28
Slipping rib syndrome can be the cause of chronic abdominal wall pain.
Thomas Inge1:30
Patients with slipping rib syndrome may have already had their appendix or gallbladder removed before arriving at the correct diagnosis.
Thomas Inge1:44
Patients with slipping rib syndrome often undergo multiple colonoscopies, CTs, and ultrasounds before diagnosis.
Thomas Inge1:51
Slipping rib syndrome is more common in teenage girls than boys.
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.
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 Inge2:12
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.
If there's a response to intercostal block, the next step is to refer to surgery.
Thomas Inge2:34
Interventional radiology performs cryoablation using needle probes at single or multiple levels for slipping rib syndrome.
Thomas Inge2:38
Cryoablation can be used intraoperatively in combination with surgery to remove rib tips or stabilize a slipping cartilaginous costal margin.
Thomas Inge3:01
Outcomes from using cryoablation for slipping rib syndrome included reduced pain scores, reduced narcotic use, and shorter length of stay in the hospital.
Patients treated with cryoablation for slipping rib syndrome were able to resume normal activities much earlier.
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 Inge3:27
Interventional radiology colleagues use the same needles for cryoablating liver lesions and lung nodules that can be applied to intercostal nerve cryoablation.
Journal of Pediatric Surgery Article REview: August Issue 2023
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.
DeFiore2:26
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.
IV PCA does not appear necessary in Nuss procedures with cryoablation and can be eliminated fairly early in a surgeon's experience.