# Slipping Rib Syndrome — GCMD Library living collection

Everything in the library about slipping rib syndrome — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 16 cited statements

## Episodes
### Surgical Management
- [Update Course Rewind: Part 2 Non-Pectus Uses of Cryoanalgesia 2024](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622) — video · 4:23 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622.md)

### Evidence & Research
- [Initial Outcomes Using Cryoablation in Surgical Management of Slipping Rib Syndrome](https://library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456) — video · 1:03 · [machine version](https://library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456.md)
- [Journal of Pediatric Surgery Article REview: August Issue 2023](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977) — podcast · 17:30 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=0) Cryoablation in Slipping Rib Syndrome Surgery (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=0) Cryoablation in Nuss Procedures: Impact on Hospital Stay and Opioid Use (Ep 2)
- [5:07](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=307) Management of Primary Spontaneous Pneumothorax in Children (Ep 2)
- [8:23](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=503) Updated APSA Guidelines for Solid Organ Injury Management (Ep 2)
- [11:16](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=676) Cryoablation for Slipping Rib Syndrome (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=0) Introduction and Series Context (Ep 3)
- [0:56](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=56) Percutaneous Cryotherapy Approaches (Ep 3)
- [1:21](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=81) Slipping Rib Syndrome: Pathophysiology and Presentation (Ep 3)
- [2:12](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=132) Treatment Algorithm for Slipping Rib Syndrome (Ep 3)
- [2:56](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=176) Cryoablation Outcomes in Slipping Rib Syndrome (Ep 3)
- [3:23](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=203) Case: Cryoablation for Rib Fractures (Ep 3)
- [3:49](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=229) Summary and Tool Adaptation (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "The study was a retrospective review conducted in Phoenix between 2018 and 2022" — Cecilia Gigena (host_summary) [Ep 1 · 0:11](https://library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=11)
- "The study compared length of stay and opiate use in patients undergoing cartilaginous rib excision with and without cryo" — Cecilia Gigena (host_summary) [Ep 1 · 0:16](https://library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=16)
- "The study included 98 patients total" — Cecilia Gigena (host_summary) [Ep 1 · 0:27](https://library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=27)
- "68 patients underwent resection without cryo" — Cecilia Gigena (host_summary) [Ep 1 · 0:27](https://library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=27)
- "22 patients underwent resection with cryo" — Cecilia Gigena (host_summary) [Ep 1 · 0:27](https://library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=27)
- "8 patients underwent a NAS procedure plus cartilaginous resection with cryoalgesia" — Cecilia Gigena (host_summary) [Ep 1 · 0:27](https://library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=27)
- "Patients who underwent resection with cryo had significantly less opiate use" — Cecilia Gigena (host_summary) [Ep 1 · 0:43](https://library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=43)
- "Patients who underwent resection with cryo stayed one day less than patients without cryo, though this difference was not statistically significant" — Cecilia Gigena (host_summary) [Ep 1 · 0:43](https://library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=43)
- "Cryoablation is not limited to thoracotomy or thoracoscopy; there are novel ways to use cryotherapy in a percutaneous approach." — Lizzie Lee (host_summary) [Ep 3 · 0:56](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=56)
- "Interventional radiology has percutaneous needle options available for cryotherapy beyond the standard cryoprobe." (clinical) [Ep 3 · 1:04](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=64)
- "Cryoablation has shown real benefits for rib fractures, slipping rib syndrome, and other endochondromas." — Thomas Inge (clinical) [Ep 3 · 1:12](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=72)
- "Slipping rib syndrome is a condition with cartilaginous union at the end of the ribs, particularly for floating ribs but also for false ribs." — Lizzie Lee (host_summary) [Ep 3 · 1:21](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=81)
- "Laxity in costochondral junctions and impingement on intercostal nerves as the ribs slip and float causes slipping rib syndrome." — Thomas Inge (clinical) [Ep 3 · 1:28](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=88)
- "Slipping rib syndrome can be the cause of chronic abdominal wall pain." — Thomas Inge (clinical) [Ep 3 · 1:30](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=90)
- "Patients with slipping rib syndrome may have already had their appendix or gallbladder removed before arriving at the correct diagnosis." — Thomas Inge (clinical) [Ep 3 · 1:44](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=104)
- "Patients with slipping rib syndrome often undergo multiple colonoscopies, CTs, and ultrasounds before diagnosis." — Thomas Inge (clinical) [Ep 3 · 1:51](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=111)
- "Slipping rib syndrome is more common in teenage girls than boys." — Lizzie Lee (host_summary) [Ep 3 · 1:58](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=118)
- "Patients with slipping rib syndrome often present with somatic tenderness of the abdominal wall that can be elicited by asking them to flex or crunch their abdominal muscles, but they really won't have a visceral type tenderness." — Lizzie Lee (host_summary) [Ep 3 · 2:01](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=121)
- "The usual approach for patients with slipping rib syndrome is to refer them to chronic pain for evaluation and intercostal block with steroid and long-acting local anesthetic." — Thomas Inge (clinical) [Ep 3 · 2:12](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=132)
- "If patients get pain relief from the intercostal block with ropivacaine and dexamethasone, the next step is to refer them to interventional radiology for ultrasound-guided cryotherapy." — Lizzie Lee (host_summary) [Ep 3 · 2:25](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=145)
- "If there's a response to intercostal block, the next step is to refer to surgery." — Thomas Inge (clinical) [Ep 3 · 2:34](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=154)
- "Interventional radiology performs cryoablation using needle probes at single or multiple levels for slipping rib syndrome." — Thomas Inge (clinical) [Ep 3 · 2:38](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=158)
- "Cryoablation can be used intraoperatively in combination with surgery to remove rib tips or stabilize a slipping cartilaginous costal margin." — Thomas Inge (clinical) [Ep 3 · 3:01](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=181)
- "Outcomes from using cryoablation for slipping rib syndrome included reduced pain scores, reduced narcotic use, and shorter length of stay in the hospital." — Lizzie Lee (host_summary) [Ep 3 · 3:13](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=193)
- "Patients treated with cryoablation for slipping rib syndrome were able to resume normal activities much earlier." — Lizzie Lee (host_summary) [Ep 3 · 3:19](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=199)
- "For patients with chest rib fractures who get stuck on a ventilator, cryoablation can do a world of good by anesthetizing the intercostal spaces that are the problem." — Thomas Inge (clinical) [Ep 3 · 3:27](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=207)
- "Interventional radiology colleagues use the same needles for cryoablating liver lesions and lung nodules that can be applied to intercostal nerve cryoablation." (clinical) [Ep 3 · 3:55](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=235)
- "From the first quarter compared to the fourth quarter of the study, there was 74% less opioid use in Nuss procedures with cryoablation" (host_summary) [Ep 2 · 2:26](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=146)
- "80% of patients achieved early discharge home by postoperative day number 2 in the fourth quarter of the Nuss cryoablation study" (host_summary) [Ep 2 · 2:26](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=146)
- "The reduction in opioid use and length of stay was primarily related to discontinuing use of IV PCA during the study period" — Cecilia Gigena (host_summary) [Ep 2 · 2:46](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=166)
- "IV PCA does not seem to be necessary for Nuss procedures with cryoablation and can be eliminated fairly early in a surgeon's experience" — Cecilia Gigena (host_summary) [Ep 2 · 2:46](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=166)
- "The learning curve for cryoablation in Nuss procedures is not about technique but about pain protocols used around the time of surgery" — Cecilia Gigena (host_summary) [Ep 2 · 4:03](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=243)
- "Cryoablation implementation requires a protocol or regimen including pain team involvement preoperatively and postoperatively, with adjuncts such as gabapentin" — Cecilia Gigena (host_summary) [Ep 2 · 4:40](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=280)
- "Simple aspiration was successful in 33% of children with primary spontaneous pneumothorax" — Shawn St. Peter (host_summary) [Ep 2 · 6:15](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=375)
- "66% of children with primary spontaneous pneumothorax still required VATS after aspiration" — Shawn St. Peter (host_summary) [Ep 2 · 6:15](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=375)
- "Median length of stay with successful aspiration for pneumothorax was 20 hours (less than a day)" — Shawn St. Peter (host_summary) [Ep 2 · 6:15](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=375)
- "Median length of stay after VATS for pneumothorax was 3 days" — Shawn St. Peter (host_summary) [Ep 2 · 6:15](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=375)
- "For patients who went to VATS immediately after failed aspiration, median length of stay was 3.1 days, compared to 6 days for patients from the Midwest Pediatric Surgery Consortium" — Cecilia Gigena (host_summary) [Ep 2 · 7:02](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=422)
- "The entire treatment algorithm for spontaneous pneumothorax is split upon whether the patient is actively leaking air or had a bleb that popped and sealed" — Shawn St. Peter (clinical) [Ep 2 · 7:38](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=458)
- "Updated APSA guidelines for solid organ injury management use the APSA framework: Admission, Procedures, Set free (discharge), and Aftercare" — Em Gootee (host_summary) [Ep 2 · 8:46](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=526)
- "The most important change in the updated APSA guidelines is that discharge of a patient is not related to the severity of the injury but to the clinical condition of the patient" — Em Gootee (host_summary) [Ep 2 · 9:34](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=574)
- "Activity restriction for solid organ injuries should be for two weeks at first, then adjusted based on level of injury" — Em Gootee (host_summary) [Ep 2 · 10:02](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=602)
- "Solid organ injury management decisions should be based on clinical symptoms and signs of ongoing bleeding rather than solely on grade of injury" — Regan Williams (clinical) [Ep 2 · 10:48](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=648)
- "In the slipping rib syndrome study, 68 patients had rib resection without cryoablation (receiving other blocks), 22 had extrathoracic cryoablation, and 8 had slipping ribs resected as part of Nuss procedure" — Cecilia Gigena (host_summary) [Ep 2 · 11:53](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=713)
- "91% of cryoablation patients had cryoablation of T9 and T10 intercostal nerves with no documented abdominal wall laxity at 16-day follow-up" — Cecilia Gigena (host_summary) [Ep 2 · 13:10](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=790)
- "Patients who underwent rib excision with cryoablation used significantly less opioids in hospital compared to rib excision without cryoablation" — Cecilia Gigena (host_summary) [Ep 2 · 13:10](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=790)
- "Median length of stay was 1 day for patients with rib excision with cryoablation compared to 2 days for patients with rib excision without cryoablation" — Cecilia Gigena (host_summary) [Ep 2 · 13:10](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=790)
- "Visual analog scale pain scores were similar across all slipping rib syndrome groups, but opioid requirement was significantly less in the cryoablation group" — Crystal Lai (clinical) [Ep 2 · 13:57](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=837)
- "Abdominal wall laxity after T9 and T10 cryoablation was seen only once, in a pectus patient rather than a slipping rib patient" — Lisa McMahon (clinical) [Ep 2 · 14:27](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=867)
- "Patients with very low pectus deformities may have more discomfort in the lower costal margin area because it gets out of the field of T7 and T8 where most cryoablation is performed" — Cecilia Gigena (host_summary) [Ep 2 · 14:46](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=886)

## Changelog
- Sep 25: 3 items added automatically

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