Slipping Rib Syndrome .org
HOW IS SLIPPING RIB SYNDROME DIAGNOSED?
There are 4 ways that slipping rib syndrome can be diagnosed, but first, I want to talk abut how it is not diagnosed, and why.
Most SRS patients, have extensive tests before we (usually though frustration and our own research) determined the cause of the issues.
Even if the ribs are completely detached, SRS does not show up on x-rays, MRI, or in regular ultrasound or regular CT scans, because during these scans the body is lying flat, causing the spine to straighten, and ribs that sublux and move under other ribs are likely to be in their natural position. Another problem is that typically, these scans do not show the costal cartilage, so any cartilage that is broken, will not be detected visually. Blood tests do not show SRS as it is a mechanical problem, it does not cause infection, and often does not cause enough inflammation to show up on a full blood count.
It is at this stage, when doctors have exhausted most of the resources available to them with no result, that many of them lose interest, or declare that the pain and discomfort we are experiencing is all in our head, but there is some good news. There are ways to detect and diagnose SRS and they are all very simple. The bad news is that currently, many professionals in the medical world do not know about these tests and the positive results that they can produce.
The first way to diagnose SRS is by palpation (feeling) this takes a very experienced doctor that specialises in SRS to feel the ribs and how much they move. Here is a video of Dr. Adam Hansen, whom many of us consider to be 'the guru' of SRS, diagnosing a patient using clinical examination. It is worth pointing out that it is Dr. Hansen's surgery (known as Hansen's Repair, the Hansen method, Hansen Technique, or Hansen Procedure) that has allowed many of us to go on to live relatively pain-free and normal lives. You can read more about this surgery here.
Dr. Adam Hansen - Slipping Rib Syndrome Evaluation
The second way to, sometimes successfully (but not always) diagnose Slipping Rib Syndrome is using a technique known as 'The Hooking Manoeuvre'. In this procedure, a doctor, or physiotherapist will hook their fingers under the costal margin of the ribcage and pull up. This causes a slipped rib to sublux (go under the rib above) reproducing the pain and sometimes giving a popping or clicking sound as it makes contact. The hooking manoeuvre is very painful and is now outdated, as the next diagnostic tool that I want to show you (dynamic ultrasound) is not only a pain-free way to diagnose SRS, but also gives the surgeon a better idea of which ribs are involved and what is going on inside the body prior to surgery. I have, however included the hooking manoeuvre here, as some people may not have access to other methods of diagnosis.
The third known method for diagnosing slipping rib syndrome is dynamic ultrasound. Many doctors will tell you that Ultrasound and Dynamic ultrasound are the same. They are the same in that they use the same technique and equipment, however with the operative word being 'dynamic' these involve movement of the patient during the scan as opposed to lying flat. In dynamic ultrasound the patient typically performs crunches, whilst the radiographer holds the transducer in a fixed position. This shows and records the subluxation and abnormal movement of the affected ribs, thus diagnosing the condition.
This takes a skilled radiographer with experience of SRS who knows what to look for, and how to find and record it, so if you are seeking diagnosis it is important that you go to the right person.
In the UK as of January 2022 there is currently only one known radiographer, in London with enough experience of dynamic ultrasound and knowledge of this condition to confirm Slipping Rib Syndrome reliably. Details of radiographers who specialise in dynamic ultrasound capture of SRS in the USA, Canada, UK and Europe can be found here.
If you are unable to access a radiographer who specialises in diagnosing SRS you can download the ultrasound protocol document here to take to your local ultrasound radiographer for them to read. This is a scientific document from Monique Riemann (Below) et al, that explains in detail how to locate and capture footage of the slipping rib and confirm diagnosis.
Explanation and example of Dynamic Ultrasound to diagnose SRS.
There has been considerable success in diagnosing Slipping Rib Syndrome by obtaining a 3D rendering of a CT. A regular CT image will not show the costal cartilage but a 3D rendering will show the cartilage and will allow the viewer to see if it is broken.
