Dynamic ultrasound evaluation of patients with suspected slipping rib syndrome: five years in

To evaluate the efficacy of a dynamic ultrasound-based diagnostic protocol designed to improve the diagnosis of slipping rib syndrome in the largest cohort of pediatric patients to date.

A retrospective chart review was conducted for patients who presented to Phoenix Children's Hospital with suspected slipping rib syndrome who underwent dynamic ultrasound-based evaluation from March of 2017 to May of 2022. A focused history and detailed imaging were performed, and dynamic ultrasound exam was conducted and compared with surgical and physical exam findings from pediatric surgeons specializing in slipping rib syndrome. Statistical analyses were performed.

Two hundred twenty-seven patients were evaluated for slipping rib syndrome during the study period, resulting in 301 ultrasound evaluations, with 78% of patients undergoing a single evaluation and 22% undergoing multiple assessments. There were 159 (70%) female and 68 (30%) male subjects. Average age and BMI were 17.4 years and 22.4 kg/m², respectively. Dynamic ultrasound accurately detected slipping rib in 97.4% (220/226; 94.3%, 99.0%) and correctly found no evidence in 88.7% (63/71; 79.0%, 95.0%) of studies, respectively. The combined right and left-sided sensitivity and specificity for morphology was 55.1% (50.2%, 60.0%) and 88.0% (83.0%, 92.9%); for the crunch maneuver, was 54.1% (49.2%, 59.0%) and 92.6% (88.6%, 96.6%); and, for the push maneuver, was 54.8% (50.0%, 59.7%) and 90.7% (86.2%, 95.2%).

Dynamic ultrasound imaging of the ribs is an effective and reproducible tool for the diagnosis of slipping rib syndrome, demonstrating high sensitivity and specificity in pediatric patients.