Purpose or Case Report: Slipping Rib Syndrome (SRS) is a condition that affects adolescents and young adults. Dynamic Ultrasound imaging has a potential and likely significant role; however, limited data exists describing the protocol and techniques available for evaluating SRS. It is the intent of this study to describe the development of an effective and reproducible protocol for dynamic imaging in patients with SRS.
Methods & Materials: Retrospective review was performed of suspected SRS patients that presented either to the Radiology or Surgery department from March through October of 2017. 22 patients were evaluated utilizing a high frequency 12-5 linear transducer. Focused history was taken and imaging was performed at the site of pain. Images of the bilateral 7th-11th ribs were obtained in the parasagittal plane at rest and with dynamic maneuvers. Dynamic maneuvers included Valsalva, crunch, focal rib push/compression, and any other provocative movement that elicited pain per the patient. Imaging results were correlated with medical and surgical records generated by the pediatric surgeon specializing in treatment of slipping ribs.
Results: 86% (18/21) of patients had a clinical diagnosis of SRS with an average age of 17.4 years. 16 patients were female, while 6 were male. 73% (16/22) of patients were athletes, with average BMI 22.3. Dynamic ultrasound correctly detected the presence of SRS in 84% (16/19) of patients and correctly detected the absence of SRS in 100% of patients (3/3). Two of the three examinations which did not detect SRS did not utilize dynamic crunch or push maneuvers. In the last patient, crunch was performed, but push maneuver was not. All but one exam utilizing the crunch and push maneuver correctly detected SRS.
Conclusions: Dynamic Ultrasound imaging of the ribs, particularly with utilization of crunch and push maneuvers, is an effective and reproducible tool for the diagnosis of SRS.