Almost slipped through the crack: Pediatric patient with bilateral slipped rib syndrome and twelfth rib syndrome of the eleventh ribs

Abstract

Slipped rib syndrome is a rare disorder in which there is hypermobility of the anterior false ribs, resulting in the tips of the ribs moving or slipping under the superior rib. Alternatively, twelfth rib syndrome is caused by irritation of the twelfth intercostal nerve related to the hypermobility of the twelfth rib. In this report, we present a case of a 15-year-old male who presented with debilitating pain in the left posterior flank that persisted despite multiple medications and physical therapy. He was diagnosed with left-sided slipped rib syndrome and twelfth rib syndrome of the eleventh rib which was treated with eleventh rib excision. Less than one year later he developed right-sided pain and was ultimately diagnosed with right-sided slipped rib syndrome and twelfth rib syndrome of the eleventh rib for which he underwent right ninth and tenth costal cartilage excision and right eleventh rib excision. The patient then had complete resolution of his pain. A delineation between slipped rib syndrome and twelfth rib syndrome is important since they are both relatively rare and often misdiagnosed. Our case report is significant since our patient had both of these rare diseases bilaterally which to our knowledge has not been previously published. • Slipped rib syndrome and twelfth rib syndrome are rare causes of chest and back pain. • Increased awareness will decrease unnecessary studies and pain for these patients. • Our patient had bilateral SRS and twelfth rib syndrome, which has not been not previously described. • Resection of the affected rib with cryoablation of the intercostal nerve is a safe and effective treatment.