I’m going to begin this blog by discussing Slipping Rib Syndrome and these wonky ribs of mine.
I know I have mentioned it many times but I am hoping this is the last time I have to think about it. I will repeat some things you may have already read in prior blogs but I wanted to include all information in this one.
I have Slipping Rib Syndrome (SRS). This problem goes by many names – clicking rib, slipping rib, rib tip syndrome, Cyriax syndrome, rib hypermobility, intercostal subluxation, etc. SRS often goes undiagnosed but it is not as uncommon as you think.
In June of 2018, I had noticed bone on bone grinding in my lower left side ribs. After seeing the thoracic clinic for this issue, I had CT scans, referrals for rheumatology and musculoskeletal clinics and general surgeons, I had nerve blocks in my back, and I still had issues with my ribs. A lot of SRS patients suffer experiences of misdiagnosis, such as asymmetry in the rib cage – my first doctor told me this, and other issues such as doctors blaming other issues for this skeletal pain. See Stelara Infusion & Ganglionectomy Pain.
SRS patients go through unnecessary surgeries, get diagnosed with “wastebasket terms” like Costochondritis – where there is a name but no cause, etc. Patients undergo unnecessary imaging tests, like CT scans, MRIs and x-rays. I have dealt with all of this, too.
I had originally had issues with my left 11th rib, it constantly feels swollen, thicker than the rest of my ribs, with areas of on and off again swelling. Then the bone on bone grinding began, this I considered a separate, second issue, until the bone on bone grinding continued to cause issues and pain, and so it took priority.
In the beginning, I had no information on what was going on. I knew I could feel my bone/rib move out of place, and it started happening more and more, at random, and it would stop me in my tracks every time.
I did my own research, as the thoracic clinic at this point did not “appreciate” the problems I was having. I looked up rib issues and by chance stumbled upon Slipping Rib Syndrome. SRS happens when rib cartilage on a person’s lower ribs moves, essentially a dislocation that causes one rib to move up and under the rib above it.
I spent months trying to explain SRS to my thoracic care team but my surgeon was hesitant for surgery, let alone rib resection surgery. Since nerve blocks had helped the pain prior, my first surgeon suggested a neurectomy to help the nerve pains.
I had the neurectomy procedure in January 2018. four incisions on my left side, chest tube in place and I was hopeful for healing. But it didn’t help. See My Wonky Ribs and Neurectomy.
By May, I had asked to have a second opinion for the thoracic clinic after filing complaints on surgeon number one. After seeing surgeon number two for the first time, I was scheduled for a rib plating procedure in a week – that ended up being two weeks later. This surgeon actually believed me when I mentioned SRS and listened to my concerns. See Rib Plating Surgery and Thoracic Appointments.
May 15th, I had a titanium plate put in place over my costochondral area of my left side 9th and 10th ribs. There was a clear dislocation where my 10th rib meets my 9th. I was right. I had SRS. I was extremely hopeful after this procedure, as no more bone on bone grinding should stop all the pain. One incision, one titanium plate and six screws with weeks to heal.
Come November, I got sick at Thanksgiving and that cold lasted into December and Christmas. I had coughing fits that put stress on my thoracic area and my rib plate did not seem right. There was extreme pain at the bottom tip of the plate and the pain radiated into my left side and back. Something wasn’t right. See Thoracic Follow-Up & Slipping Rib Syndrome.
After three x-rays, an ultrasound, a fluoroscopy and multiple visits to the thoracic clinic and the ER, nothing was ever seen. With further research, SRS is usually not seen on imaging tests other than a diagnostic ultrasound as it is a functional separation, and costal cartilage is thin, gray and often not viewed well in these imaging tests. Usually, a basic hooking maneuver under the ribs can be helpful to diagnose and further testing and imaging can be wasteful.
I was given pain meds and shots of Toradol and left to self-heal with icy-hot and my heating blanket. I refused to believe that everything was okay and I was persistent with my surgeon number two. We scheduled to remove the plate a week later – that ended up being two weeks later, too.
Now, I was 11 days post-op from surgery as I typed this.
For this surgery, we had planned on cryoablation, removing the titanium plate, and completing a rib resection for the portion of my 10th rib costal cartilage. No chest tube was needed and although I had planned on staying at the hospital at least one night, I got to come home.
My surgeon felt that I could benefit without cryoablation, nerve blocks were used instead. It was mentioned that should nerve pain persist, that we would continue with nerve blocks until the nerves are completely dead. Using last May’s incision scar, they opened a much longer area this time – around 4 inches long.
The titanium plate from last May’s surgery was removed with all 6 screws. Mind you, when the surgeon got inside, one screw was loose. (Insert joke here). So, the 10th rib was still mobile, still moving and slipping up and under my 9th rib above it, still causing me pain and irritating the nerves and chest area.
I knew, KNEW something wasn’t right and I repeatedly said this during every x-ray, clinic visit, ER visit, during the ultrasound and fluoroscopy. I told every doctor that would listen that something wasn’t right, I had either cracked the rib, moved the plate, screws were moved, something was wrong. And I was right. Again. Just like I was right when I said I had a dislocated rib from the beginning, and they didn’t believe me until they opened my chest wall for the second surgery.
The 10th rib bone, with the cartilage tip surgically removed, was sutured to the 9th rib cartilage above it, so this rib shouldn’t slip or move anymore. The muscle was sutured on top of that, I was super-glued shut, my x-rays post-op were clear, so I got to go home.
I was given pain medication and told to follow up with my surgeon in two weeks. I was put on light-limited duty for 6 weeks or more, taking it easy on the ribs and deep incision wound. No heavy lifting, drive with caution, rest as much as possible. I still have my consultation for physical therapy to look forward to and hopes that this is the last of my thoracic issues.
My first meal post-op was ribs. Out with the old and in with the new.
I did ask before surgery, after surgery, and multiple times since surgery if I could get the rib portion that was removed returned to me. I have gotten my hardware that was removed but getting pathology specimens is more difficult to do, especially with VA procedures and policies. I am looking at making a piece of jewelry with the titanium plate, so any information on how to do that would be helpful.
The super-glue holding me together fell off on day 9 post-op, and the incision is looking very good. I know for the neurectomy, I got infections at 1-month post-op and 2-months post-op, with the stitches being rejecting and forcing themselves out of my body. I am hopeful for no complications this time.
I am still sore, still on medication, but I am trying to be more mobile and get out of the house to do things. I notice that after a few hours of sitting up straight or doing too much, my side starts to hurt and I need to go home to lie down. I am having residual nerve pains when I move, sneeze or cough but hopefully that will subside once this wound fully heals. Sleeping has been difficult and getting up or down is not easy but I am getting there.
I do wish I had been more vocal with my thoracic care team and surgeon number one. I wish I would have pressed for a second opinion prior to the first surgery, and I wish I could have stressed to my care team that rib resections were more helpful than plating procedures based on SRS research. I wish for and am regretful for a lot of things dealing with SRS and my experience. But all I can do is keep looking forward.
Now, I am just shy of one-month post-op. I have seen the Thoracic clinic for my follow-up and I have all but been released from their care. I had follow-up blood work and a follow-up chest x-ray to view my lungs and chest, too.
I will see them again at the 6-week point of my follow-up and I will continue to keep them in the loop for pain management. Even though there is not much more they can offer, they can offer a direct line to pain management if and when I need nerve blocks for the lingering pain.
I am not 100% healed and I have been suffering from the flu for the last week – a separate blog about that will be finished as soon as I can. I also need to update on GI, Stelara #13, my MRI Enterography and everything else but this sickness has been no fun. The coughing, vomiting, and hot flashes have not been ideal for healing and have left my ribs and xiphoid process area extremely sore.
I am trying but my body is fighting me tooth and nail.
I will end this blog here, as it has already been too long since my last post.
For me, It Could Be Worse. (And look, no more titanium plate in my x-rays!)
CURE for IBD: For those of you who are continuing to donate to the Cure for Crohn’s and Colitis, I encourage you to donate towards my team page with CURE for IBD – where 100% of the funds WE raise will be allocated to IBD research for a cure. That’s right, 100%!!
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