In this insightful recap from the 12th Annual Update Course in Pediatric Surgery, Dr. Thomas Inge of Lurie Children’s Hospital explores emerging uses of cryoanalgesia beyond pectus repair. The video delves into novel applications of cryotherapy for conditions like slipping rib syndrome and rib fractures—highlighting how interventional radiology tools, including percutaneous needle probes, can offer powerful pain relief and reduce narcotic use and hospital stay.
Key Highlights:
Slipping Rib Syndrome: Often overlooked in teens, this condition can be addressed with intercostal blocks and cryoablation.
Percutaneous Cryoablation: A new frontier in treating rib fractures and chronic pain using ultrasound-guided techniques.
Multidisciplinary Approach: Collaboration between surgery and IR expands treatment options for hard-to-diagnose chest wall pain.
This session emphasizes the evolving role of cryoanalgesia as a versatile, minimally invasive tool in pediatric surgical care.
Type: video · 4 min · posted 2025-06-30 Canonical: https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622 ## Chapters - [0:00](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=0) Introduction and Course Framework - [0:56](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=56) Percutaneous Cryotherapy Applications - [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 - [2:12](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=132) Treatment Pathway for Slipping Rib Syndrome - [3:23](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=203) Cryoablation for Rib Fractures - [4:04](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=244) Summary and Closing ## Statements - "Cryoablation is not limited to just thoracotomy or thoracoscopy" — Lizzie Lee (clinical) [0:56](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=56) - "There are novel ways to use cryotherapy in a percutaneous approach" — Lizzie Lee (clinical) [1:00](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=60) - "Cryoablation shows real benefits for rib fractures, slipping rib syndrome, and other endochondromas" — Thomas Inge (clinical) [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, for floating ribs in particular, but also for false ribs" — Lizzie Lee (clinical) [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 causes impingement on intercostal nerves as the ribs slip and float" — Thomas Inge (clinical) [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) [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 without arriving at the right diagnosis" — Thomas Inge (clinical) [1:44](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=104) - "Slipping rib syndrome is more common in teenage girls than boys" — Lizzie Lee (epidemiological) [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" — Lizzie Lee (clinical) [2:01](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=121) - "Patients with slipping rib syndrome really won't have a visceral type tenderness" — Lizzie Lee (clinical) [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" — Thomas Inge (clinical) [2:12](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=132) - "Chronic pain can do an evaluation and do an intercostal block, usually a steroid as well as a long acting local" — Thomas Inge (clinical) [2:17](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=137) - "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 (clinical) [2:25](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=145) - "If there's an actual response to intercostal block, the next step is to refer to surgery" — Thomas Inge (clinical) [2:34](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=154) - "IR performs ablation at just the right level or more commonly multiple levels" — Thomas Inge (clinical) [2:44](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=164) - "Cryoablation can be used intraoperatively in combination with surgery to remove the rib tips or to stabilize a slipping cartilaginous costal margin" — Thomas Inge (clinical) [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" — Lizzie Lee (clinical) [3:13](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=193) - "Outcomes from using cryoablation for slipping rib syndrome included reduced narcotic use" — Lizzie Lee (clinical) [3:13](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=193) - "Outcomes from using cryoablation for slipping rib syndrome included shorter length of stay in the hospital" — Lizzie Lee (clinical) [3:13](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=193) - "Patients were able to resume normal activities much earlier after cryoablation for slipping rib syndrome" — Lizzie Lee (clinical) [3:19](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=199) - "If you have someone come in with chest or fractures that gets stuck on a ventilator, you can do a world of good with cryoablation by anesthetizing just those intercostal spaces that are the problem" — Thomas Inge (clinical) [3:27](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=207) - "IR colleagues use the same needles for cryoablating liver lesions and lung nodules that can be applied to intercostal nerve ablation" (clinical) [3:55](https://library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=235) ## Transcript Global Cat MD along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe. Hello pediatric surgery family. I'm Lizzie Lee from Cincinnati Children's Hospital Medical Center. In this video series, we'll be recapping the sessions and sharing the key highlights from our 12th annual update course in pediatric surgery, which was held in August 2024. This year we introduced a new approach to classify practice changing ideas at our update course. Presentations now fall into three categories green circles for established practices, blue squares for promising newer practices, and black diamonds for early adopter practices only. Today we are talking about cryoanalgesia uses outside of pectus repair with pediatric surgeon Doctor Thomas Inge from Laurie Children's Hospital. This is video number 2 of this topic. If you'd like to watch video number 1 1st, it's linked below. Cryoablation is not limited to just thoracotomy or thoracoscopy. There are novel ways to use cryotherapy in a percutaneous approach. Besides the standard cryoprobe, once you start using the tools that the IR folks have available, which includes percutaneous needle options, what else you can do? We've seen some real benefits of cryo treatment, cryoablation for rib fractures, slipping rib syndrome, and other endochondromas, as you see here. Slipping rib syndrome is a condition with cartilaginous union at the end of the ribs, for floating ribs in particular, but also for false ribs. We see laxity. In some of these costochondral junctions and impingement on these intercostal nerves as the ribs slip and float and encroach upon these nerves, slipping rib syndrome can be the cause of chronic abdominal wall pain. We've all seen patients that come to us with it, they're already out, maybe even their gallbladder out, and nobody has arrived at the right diagnosis. A lot of colonoscopies and CTs and ultrasounds, they can end up. In your clinic, so always assess for it. Slipping rib syndrome is more common in teenage girls than boys. They 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. So what is the usual approach for patients with slipping rib syndrome? Refer them to chronic pain. Chronic pain can do an evaluation and do an Intercostal block, usually a steroid as well as a long acting local. If they do 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. If there's an actual response, the next step is to refer to surgery. Sometimes patients want to know is there an in between now that there are these needle probes for the cryo. Our IR folks are doing. An ablation, they may do an ablation at just the right level or more commonly multiple levels. This is an intraoperative X-ray of them doing their needle probe placements and freeze thaw cycles. This paper looked at outcomes from using cryoablation for slipping rib syndrome. They've used cryoablation intraoperatively, so the marriage of the surgery to remove the rib tips or to stabilize a slipping cartilaginous costal margin. And then use cryoablation at the same time. Outcomes included reduced pain scores, reduced narcotic use, and shorter length of stay in the hospital. Patients were able to resume normal activities much earlier. Let's review a case involving the use of cryoablation to treat rib fractures. If you have someone come in with chest or fractures that gets stuck on a ventilator, you can do a world of good with this technique by anesthetizing just those intercostal spaces that are the problem. In this 16-year-old male with 5 rib fractures, doing multi-level percutaneous intercostal nerve cryoablation helped to reduce his pain, and he was able to be extubated. There's multiple ways to apply this tool. We're used to doing it with the standard probe from the intrathoracic approach. You can refer to the IR colleagues who are using these same needles for cryoablaating liver lesions and lung nodules. It's just a different application of the tools that they have. In summary, cryoanalgesia is being adapted for various conditions beyond thoracotomies, leveraging tools from interventional radiology to treat patients with rib fractures and slipping rib syndrome. Global Cat MD along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe. --- Not medical advice · citation policy: https://library.globalcastmd.com/ai