I wasn’t sure whether to post this topic since I don’t know whether it is appropriate for this forum, but I figured I’d share it since I think it is relevant to my condition and others may find it helpful.
I strongly believe I have a condition called Slipped Rib Syndrome that could be a very important underlying piece of the puzzle for me. I have had chronic low back pain for many years that predates the diagnosis of thoracic outlet syndrome and Eagle Syndrome that hasn’t been explained by looking at my lumbar spine anatomy. It hasn’t been relieved by:
- Chiropractic
- Massage
- Stretching
- Physical therapy
- PRP/Prolotherapy injections
I recently came across this video by Dr Adam Hansen that seemed to connect some dots for me:
Furthermore, upon joining the Facebook Group for Slipped Rib Syndrome, it seems that a lot of people with this condition also develop Thoracic Outlet Syndrome, as well as other vascular compressions, most notably MALS.
The way this seems to work is that:
- Due to chest wall injury a person develops a slipped 10th rib, and possibly 9th rib. They become detached from the costal margin and become “floating”. They move around and irritate the intercostal nerves and sometimes poke the diaphragm.
- This affects breathing since the diaphragm attaches to the bottom ribs and the slipped ribs create inflammation and irritation to the diaphragm. People then cannot breath as fully into the lower part of their lungs and instead compensate by breathing into their upper lungs utilizing the scalene muscles.
- Often people develop weak abdominal and lower back muscles because the slipped ribs are constantly irritating the intercostal nerves and therefore the movements required to strengthen the core cause intense pain.
- The combination of weak core muscles and altered breathing mechanics changes posture and can cause the shoulders to round and alteration of the cervical spine alignment.
The connection to MALS seems to be that an alternation of the diaphragm function or position could alter to median arcuate ligament anatomy such that it begins to compress the celiac artery.
In my case, I had thoracic outlet syndrome decompression surgery and my surgeon (Dr Gelabert at UCLA) noted that my scalene muscles had “hypertrophied” to roughly four times the normal size. As most of us know, scalene muscles can cause compression of the brachial plexus and subclavian vein/artery, as well as be involved in jugular vein compression.
In my case, I suspect slipped ribs at the bottom of my ribcage had altered my breathing mechanics such that my scalenes became overdeveloped and I started having the compression disorders in the neck that I continue to have (though some symptoms improved after thoracic outlet decompression surgery).
As far as what my next steps are, I clearly need to address the jugular outflow problem in my neck, as well as the possible CSF leak(s), but I may need to address the slipped ribs if that truly is a major underlying cause of my problems.
I had a recent chest CTA and I used that to create a 3D model. With a 3D reconstruction, you can usually see the cartilage and thus see if it is detached from the costal margin. In my case, it looks like the 9th and 10th ribs are “floating” or slipped.
I have an appointment with Dr Joseph Forrester at Stanford in late August, about two weeks after I see Dr Hepworth for the first time. He should be able to tell me whether I have this or not.
Has anyone else had any slipped ribs, or other ribcage anomalies? Apparently this condition is more common among those with Ehlers-Danlos syndrome (which I don’t think I have).
Heather
