Intercostal nerve radiofrequency ablation for slipping rib syndrome: a case report

Slipping rib syndrome (SRS) is an underdiagnosed condition causing chronic debilitating thoracic wall pain due to hypermobility of costal cartilage and irritation of intercostal nerves. Conservative management includes analgesics and intercostal nerve blocks. When these measures fail, surgical rib fixation is considered. This case is the first reported successful use of intercostal nerve radiofrequency ablation (RFA) as a preoperative bridge in the management of SRS. We report a case of a 25-year-old woman with hypermobile Ehlers-Danlos Syndrome and slipping rib syndrome who developed recurrent rib fractures and chronic chest wall pain. After limited relief with opioids and intercostal nerve blocks, she underwent bilateral T7-T10 intercostal nerve RFA, resulting in complete pain resolution and opioid tapering. She later proceeded with bilateral rib fixation and remained pain-free postoperatively. Intercostal nerve RFA offers a promising minimally invasive treatment for patients with chronic intercostal neuralgia due to SRS, particularly in high-risk surgical patients. This case also supports the potential value of interdisciplinary collaboration between pain specialists and thoracic surgeons to optimize care for patients undergoing thoracic surgeries.