[The painful floating-rib syndrome]

Attention is drawn to a painful syndrome in the front of the chest, due to abnormal mobility of a rib that has lost the normal cartilaginous connection with that above it. The syndrome is common enough, though little understood. Deep, continuous, dull and gravative pain is felt in the bottom of the chest and top of the abdomen, with distribution over the base of the hemithorax involved. It is relieved by rest and exacerbated by the effort and certain postures. One or more ribs on one or both sides may be affected, though the Xth is most commonly concerned. The condition may be the direct or indirect result of trauma, or congenital. Abnormal development of the XIth rib may result in its riding over that above it and so causing pain. The formation of parietal algogenous sites is thought to be primarily responsible for pain. These sites result from rubbing of the end of the free cartilage on neighbouring structures. Direct compression of the corresponding trunk may also be involved. Objective diagnosis is based on topical signs. The floating rib is readily recognised as the cause of pain and the syndrome itself is known as the painful slipped (better, floating) rib syndrome. Satisfactory results are obtained by deep analgesic infiltration at the end of the free cartilage and can be prolonged by rest. Reference is made to previously reported data concerning functional disorders of the extrahepatic bile ducts in subjects with this syndrome in the light of a more ample case series. The radiological picture is usually marked by gall bladder hypertonia and hyperkinesis, with occasional sphincter involvement. The physiopathogenetic interpretation of these associated parietobiliary manifestations is discussed in the light of experimental and therapeutic evidence. Their clinical interest is also stressed.