Minimally invasive surgical approach for slipping rib syndrome: A case report

Slipping rib syndrome (SRS) is caused by abnormal subluxation of floating ribs, resulting in chronic pain and possible tissue damage. Its prevalence is often overlooked, as it shares symptoms with other musculoskeletal conditions, and is more common in young females and athletes. Symptoms include pain along the lower rib margin, aggravated by trunk movements, deep breathing and coughing. Treatment usually starts conservatively with physiotherapy and analgesics. In severe cases, extrapleural rib resection may be required.

In April 2023, a 24-year-old woman presented with persistent right hemithorax pain in the eleventh rib for one year. Instrumental examinations, including ultrasonography and magnetic resonance imaging, were negative for abdominal and osteochondral abnormalities. The pain intensity, rated 8/10 on the numeric rating scale (NRS), remained unresponsive to pain therapy. After a careful literature review and discussion with the patient, we opted for a minimally invasive surgical approach. Under general anesthesia, a mini-thoracotomy was performed along the anterior course of the eleventh rib. After exposure, abnormal rib mobility was detected, which led to resection of the medial margin and anchoring to the overlying rib with nonabsorbable sutures. Histological examination revealed no abnormalities. The patient was discharged on the first postoperative day. Pain decreased significantly, reaching 1/10 on the NRS at one month. At 3 months, the patient had mild fluctuating pain (2/10) requiring occasional analgesics but did not interfere with daily activities.

Minimally invasive rib-preserving surgery effectively reduces pain and hospitalization time, offering a valid alternative to conventional rib resection for refractory SRS.