Diagnosis of Slipped Rib Syndrome and Treatment Using the Hansen's Repair

Joel Dunning

doi:doi:10.25373/ctsnet.13517957

Monday, January 11, 2021

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Dunning J. Diagnosis of Slipped Rib Syndrome and Treatment Using the Hansen's Repair. January 2021. doi:10.25373/ctsnet.13517957

This video presents the diagnosis and treatment of slipped rib syndrome, a syndrome that is often missed. The Hansen's repair is a novel and very simple way to address this problem.

Slipped rib syndrome presents with significant pain over the anterior lower rib cage. It is worse on movement and the hook test reproduces the extreme pain. Dynamic ultrasounds can also help with the diagnosis, although most patients’ pathways are littered with a long line of normal tests, and many patients are left feeling that there is no organic cause, often having had a futile cholecystectomy.

The author encourages all cardiothoracic surgeons to familiarize themselves with this condition, which is now simple to resolve with the Hansen's repair technique, taking no more than 10 minutes to perform (1).

Reference

Hansen AJ, Toker A, Hayanga J, Buenaventura P, Spear C, Abbas G. Minimally invasive repair of adult slipped rib syndrome without costal cartilage excision. Ann Thorac Surg. 2020;110(3):1030-1035.

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Comments

Submitted by Patrick McConnell on Wed, 2021-01-13 15:41

Great video. I have not done this because of some early experiences with suturing costal cartilage with a variation on the true slipping rib and that is costal fracture or pseudofracture of the 8/9 ribs as they become disarticulated at the costal cartilaginous intersection near the insertion of the distal sternum. This creates a very clear popping feeling and sensation on exam and my attempts to stabilize with stitches all failed and required resection with instant effect. That said, I've lumped this truer form of 11 on 10th rib or 12 on 11 with this alternative form and so I may now have confidence to adopt this for these true slipping ribs. I also totally sympathize with the anguish that these patients have in finding someone to listen to them and the relief they have when someone says to them - I know what the problem is and how to fix it!

Submitted by Hussein Elkhayat on Thu, 2021-01-21 12:54

Thank u, we see this video and we have one patient this week that have this bilateral, previously have rib resection on the left side, this time we do suturing on the right side, pt discharged home 4 hrs postoperative and he is doing well so far Thank u again for posting this

Submitted by Alexander (Sasha) Kraev on Thu, 2021-12-23 01:30

Thank you for sharing this! I have started doing more of these cases, and seeing more pts with this. I have also found the absorbable plate for Acumed really helps to stabilize it, and decreases healing time. Check it out! https://www.acumed.net/products/chest-wall/biobridge/

Submitted by Syed Qadri on Sun, 2022-01-02 02:52

Hi Joel Very nice video and technique. I have done many and mostly I had to remove piece of rib. In some trauma patients or after some strong cough, they also develops a small lung hernia as well which I had to repair with mesh. I think it is a better technique. I have couple of patients waiting and I will try this technique. Thanks for sharing.

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Diagnosis of Slipped Rib Syndrome and Treatment Using the Hansen's Repair

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