Costal cartilage excision for the treatment of pediatric slipping rib syndrome ☆ Roxana Fu a , Corey W. Iqbal b , Dawn E. Jaroszewski a , Shawn D. St. Peter b, ⁎ a Department of Surgery, Mayo Clinic Scottsdale, Scottsdale, AZ 85054, USA b Department of Surgery, Children's Mercy Hospitals and Clinics, Kansas City, MO 64108, USA Received 23 April 2012; revised 1 June 2012; accepted 3 June 2012 Key words: Slipping rib syndrome; Costal cartilage; Pain; Pediatric Abstract Background: Costal cartilage excision is an effective treatment of slipping rib syndrome (SRS), although the diagnosis of SRS may be elusive. We review our experience with SRS in the pediatric patient. Methods: This is a retrospective review from 2000 to 2011 of patients presenting with symptoms of SRS before 18 years of age. Results: Seven patients were identified who were diagnosed with SRS and underwent costal cartilage excision. All patients presented with unilateral chest pain that was exacerbated by activity. Five patients reported a popping or clicking sensation with activity that was associated with pain. On physical examination, all patients had reproducible pain with palpation over the affected cartilage. Four patients had a mobile or popping rib with palpation, and 4 also had chest wall asymmetry. Five patients underwent imaging, and 4 patients were referred to specialists. It was a median of 2 years (0-5 years) from onset of symptoms to resection. At resection, all cartilages were grossly abnormal. There were no postoperative complications. Follow-up was complete for all patients over a median 0.9 years (0.2-2.0 years). One patient had recurrence of pain in a different location; another had persistent pain, which was less severe. Conclusions: Slipping rib syndrome presents with costal cartilage pain that is reproducible on physical examination and commonly associated with a mobile rib. Excision of the affected cartilage(s) is an effective treatment and should be considered early to avoid unnecessary diagnostic tests and evaluation, which delay definitive therapy. © 2012 Elsevier Inc. All rights reserved. Pain in the region of the costal cartilages that is owing to an abnormality in the cartilages themselves can be difficult to diagnose because cardiac and gastroenterological etiologies are oftentimes considered first. Furthermore, multiple diagnoses encompass a clinical picture of costal cartilage pain including costochondritis, Tietze syndrome, and slipping rib syndrome (SRS). Similar conditions such as costochondritis and Tietze are primarily inflammatory processes, whereas SRS is not [1]. Slipping rib syndrome is related to abnormal mobility of the lower costal cartilages leading to subluxation and pain. Cyriax [2] first described SRS in 1919. Patients present with unilateral chest pain overlying the affected costal ☆ Presented in part at the 7th Annual Academic Surgical Congress, February 14 to 16, 2012, Las Vegas, NV. ⁎ Corresponding author. Center for Prospective Clinical Trials, Children's Mercy Hospitals and Clinics, Kansas City, MO 64108, USA. Tel.: +1 816 234 300; fax: +1 816 983 6885. E-mail address: sspeter@cmh.edu (S.D. St. Peter). www.elsevier.com/locate/jpedsurg 0022-3468/$ – see front matter © 2012 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jpedsurg.2012.06.003 Journal of Pediatric Surgery (2012) 47, 1825–1827