*Department of Medical and Surgery Sciences, School of Specialization in Geriatric Medicine, University of Brescia †Department of Rehabilitation Medicine, Fondazione Poliambulanza Brescia, Italy.
Clin J Pain. 2013 Oct;29(10):e1-3. doi: 10.1097/AJP.0b013e318278d497.
Slipping rib syndrome (SRS) is a musculoskeletal cause of severe and recurrent thoracic or abdominal pain. The etiology of SRS is unknown, it seems to arise from costal hypermobility with a tendency of one of the ribs (usually from 8th to 10th but also 11th and 12th have been described) to slip under the superior adjacent rib. Its prevalence is underestimated because SRS is mainly a clinical diagnosis, frequently missed. The critical aspect of the diagnosis is knowledge of the condition itself, which, when lacking, often results in the patient being referred to many different specialists and exposed to unnecessary and costly investigations. The management of the condition includes conservative techniques such as manipulation, localized anesthetic, and steroid or anesthetic nerve block. However, where conservative therapy fails, surgical treatment, with excision of the rib, may be performed.
In this paper we describe the case of a patient with persistent and debilitating flank pain who, after many investigations, was diagnosed with SRS.
The usual conservative treatment failed, after which we treated the patient with injections of incobotulinumtoxin A into muscles inserting on the inferior side of the rib cage (quadratus lumborum muscle, muscle transversus abdomini, abdominal external oblique muscle, and recto abdomini) achieving a complete relief from pain.
To our knowledge botulinum toxin has never been proposed before for the treatment of SRS. We believe that it should be considered as a therapeutic option, especially where other medical treatments have failed or as an intermediate step before surgical intervention.
滑动肋综合征（Slipping rib syndrome，SRS）是一种严重且反复发作的胸或腹痛的肌肉骨骼病因。SRS 的病因尚不清楚，它似乎是由于肋骨的过度活动引起的，其中一根肋骨（通常是第 8 到 10 根肋骨，但也有第 11 根和第 12 根肋骨的描述）在上方相邻肋骨下滑动。由于 SRS 主要是临床诊断，经常被忽视，因此其患病率被低估了。诊断的关键是了解这种疾病本身，如果缺乏这种了解，患者通常会被转介给许多不同的专家，并接受不必要的和昂贵的检查。这种疾病的治疗包括保守技术，如手法治疗、局部麻醉、皮质类固醇或麻醉神经阻滞。然而，在保守治疗失败的情况下，可能会进行手术治疗，切除肋骨。
本文描述了一例持续性和使人虚弱的侧腰痛患者，经过多次检查后被诊断为 SRS。
常规的保守治疗失败后，我们用注射依库珠单抗毒素 A 到肋骨下插入的肌肉（腰方肌、腹横肌、腹外斜肌和腹直肌）治疗该患者，从而完全缓解了疼痛。
据我们所知，肉毒毒素以前从未被提议用于治疗 SRS。我们认为，它应该被视为一种治疗选择，特别是在其他医疗治疗失败或作为手术干预之前的中间步骤。
