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Updated: Dec 10, 2025

Transaxillary First Rib Resection for Treatment of the Thoracic Outlet Syndrome

Transaxillary First Rib Resection for Treatment of the Thoracic Outlet Syndrome

Published on: September 13, 2020

Twelfth rib syndrome: a case report.

Jaewoong Jung¹, Misoon Lee¹, Dasom Choi¹

¹Department of Anesthesiology and Pain Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea.

The Journal of International Medical Research

|September 5, 2020

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Twelfth rib syndrome causes severe loin pain, often misdiagnosed. Early diagnosis via hooking maneuver and intercostal nerve block offers immediate pain relief for this rare condition.

Area of Science:

Pain Management
Musculoskeletal Disorders

Background:

Twelfth rib syndrome is a rare cause of loin pain, frequently leading to diagnostic delays.
Lack of clinician awareness contributes to prolonged patient suffering and inadequate treatment.

Observation:

Two female patients (72 and 47 years old) presented with unexplained severe loin pain.
Standard imaging tests failed to identify the cause of their pain.

Findings:

The hooking maneuver reproduced pain in both patients, leading to a diagnosis of twelfth rib syndrome.
A twelfth intercostal nerve block provided immediate and complete pain relief for both individuals.

Implications:

Highlights the importance of the hooking maneuver in diagnosing twelfth rib syndrome.

Keywords:

Musculoskeletal pain hooking maneuver intercostal nerves loin pain nerve block twelfth rib syndrome

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Emphasizes the need for increased clinician awareness and prompt treatment with nerve blocks for effective pain management.