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At least 379 records · Page 21Linked to original sources
PubMed2005

Slipping Rib Syndrome in a Collegiate Swimmer: A Case Report.

Objective: To present the unique case of a collegiate swimmer who experienced nearly 9 months of unresolved rib pain.Background: A 20-year-old collegiate swimmer was jumping up and down, warming up before a race, when she experienced pain in the area of her left lower rib cage. She completed the event and 2 additional events that day with moderate discomfort. The athlete was evaluated by a certified athletic trainer 3 days postinjury and followed up over the next 9 months with the team physician, a chiropractor, a nonsurgical sports medicine physician, and a thoracic surgeon.Differential Diagnosis: Intercostal strain, oblique strain, fractured rib, somatic dysfunction, hepatosplenic conditions, pleuritic chest pain, slipping rib syndrome.Treatment: The athlete underwent 4 months of conservative treatment (eg, activity modification, ice, ultrasound, hot packs, nonsteroidal anti-inflammatory drugs) after the injury, independently sought chiropractic intervention (12 treatments) 4 to 6 months postinjury, was referred to physical therapy (10 visits) by a nonsurgical sports medicine physician 6 to 8 months postinjury, and finally underwent surgical intervention 9 months after the onset of the initial symptoms.Uniqueness: Slipping rib syndrome was first described in 1919. However, many health care professionals who are involved with diagnosing and treating athletes and active individuals (eg, athletic trainers, physicians) are relatively unfamiliar with this musculoskeletal condition.Conclusions: It is important for clinicians and team physicians to familiarize themselves with and consider the diagnosis of slipping rib syndrome when assessing and managing individuals with persistent abdominal and/or thoracic pain.

Journal Article↗
PubMed2006

[Combined repair of large defect caused by radical surgery of advanced tongue cancer with rib-major pectoralis myocutaneous flap carrying costal parietal pleura].

OBJECTIVE: To explore the clinical value and safety of using rib-major pectoralis myocutaneous flap carrying costal parietal pleura in combined repair of large soft and hard tissue defect caused by radical surgery of advanced tongue cancer. METHODS: Six patients with advanced tongue carcinoma involving the floor of mouth and mandible were performed combined radical neck dissection with glossectomy and mandibulectomy, which caused large soft and hard tissue defect. Six rib-major pectoralis myocutaneous flaps carrying costal parietal pleura were transferred for immediate repair of the large defects. The rib flaps were applied for the repair of mandible, and the major pectoralis myocutaneous flaps were applied for the reconstruction of tongue and floor of mouth. RESULTS: Six patients recovered well after operation. Six rib-major pectoralis myocutaneous flaps carrying costal parietal pleura survived well; the wounds of surgical incision of the oral cavity, neck, and chest healed up. The reconstructed tongue and the lower face appearance were satisfactory, the occlusion relationships were normal; the speaking as well as swallowing functions recovered. CONCLUSIONS: It's safe and reliable to use rib-major pectoralis myocutaneous flap carrying costal parietal pleura to repair large soft and hard tissue defect in oral and maxillofacial region. Opening pleural cavity and harvest costal parietal pleura would not influence patients' thoracic movement and breath function and would not cause other complications. It's simple and safe for harvesting the composite flap. Carrying costal parietal pleura assures the sufficient blood supply of rib in the composite flap.

Aged↗
PubMed1996

[A study of biomechanical coupling between spine and rib cage in the treatment by orthosis of scoliosis].

Orthoses are widely used to treat scoliotic deformities of the trunk, but the way the corrective forces are transmitted from the thorax to the spine remains not well understood, and several undesired effects such as the reduction of sagittal curvatures or weak derotations are often reported. A biomechanical finite element model of the trunk was used to investigate the hypothesis that there exist coupling mechanisms between the scoliotic spine and rib cage which may explain incomplete and unexpected results obtained by orthotic treatments. Forces of 40 N were applied on the rib hump and on the lateral side of the thorax, and their individual effects were evaluated in 3-D on the spine and thorax using several geometrical indices (transverse plane translations, axial, sagittal and frontal rotations, Cobb angles). These biomechanical simulations demonstrated the existence of coupled motions between the spine and rib cage subjected to orthotic loads. It showed that reduction of physiological sagittal curvatures (up to 30%) are possibly related to anterior orthotic loads applied on the rib hump. These loads also contribute to increase lateral shift of the spine (up to 7 mm) as well as scoliotic frontal curvatures (up to 4 degrees). Based on the results found in this study, a simple and more optimal approach to treat scoliotic deformities was proposed and consisted to apply loads laterally on the convex side and on the anterior thorax opposite to the rib hump, with a system that mechanically constrains the posterior rib hump to move backward. It was simulated on 4 scoliotic patients presenting thoracic curves between 22 degrees and 54 degrees to evaluate its practicability and it was found that derotation of the trunk (between 7 degrees and 13 degrees) and reduction of frontal curvatures (up to 4 degrees) could be done without reducing physiological sagittal curvatures. More simulations on different scoliotic configurations are necessary to find the most optimal combination of forces to produce a real 3-D correction of scoliotic deformities.

Biomechanical Phenomena↗
PubMed1988

Results of excision of a cervical rib in patients with the thoracic outlet syndrome.

Excision of a cervical rib in patients with the thoracic outlet syndrome has been the subject of debate. One surgeon's experience of 23 cervical rib excisions is presented. Ten operations produced a complete cure, eleven improvement, and two no change in the patient's condition. Of 15 cases with neurological symptoms alone, 9 were cured, 5 improved and 1 was not helped; in contrast, of 8 patients with vascular symptoms, 1 was cured, 6 were improved and 1 was not helped. We conclude that cervical rib resection is the correct treatment for patients whose symptoms are predominantly neurological. Rib resection alone may not be sufficient in patients with vascular symptoms. The management of a cervical rib with vascular involvement is discussed.

Adult↗
PubMed1981

Differentiation of rib fractures from metastases by bone scanning.

The bone scans of 471 cancer patients revealed 103 (22%) with one or more rib lesions. Of 69 patients who had serial studies, five (7%) had proven rib fractures, 13 (19%) had probable fractures, 25 (36%) had proven metastases, and 26 (38%) had probable metastases. By analyzing the intensity and appearance of rib lesions in serial bone scans, it was concluded that there is a high probability that rib lesions detected by bone scanning are fractures if 1) they are focal as opposed to linear, and 2) they decrease in intensity within three to six months or they are aligned so as to involve two or more ribs in the same location.

Bone Neoplasms↗
PubMed1980

The vascular complications of cervical rib.

The consequences of cervical rib do not appear to be widely understood. Whilst most cervical ribs cause little or no trouble, and, at the most, require shoulder raising exercises, some are the cause of serious nerve compression and sometimes arterial compression. Much confusion has existed in the understanding of the vascular manifestations of cervical rib, and this confusion has often led to incorrect treatment with serious consequences. In this regard it is particularly important for the surgeon to deal with the diseased artery at the same time as the cervical rib is excised. Nine cases of cervical rib with arterial compression are reported. The importance of recognition of arterial compression, before surgery is undertaken, is stressed.

Adult↗
PubMed1995

Rib cage distortion in a canine model of flail chest.

Although blunt chest injuries frequently lead to respiratory failure, the effects of flail chest on the mechanics of breathing have not been evaluated. In the present studies, we have measured the respiratory displacements of the ribs and sternum and the electromyograms (EMG) of the parasternal and external intercostal muscles in eight supine, anesthetized, spontaneously breathing dogs before and after the third to sixth ribs on the right side of the chest were fractured both dorsally and ventrally. After flail, the fractured ribs moved inward, rather than outward, during inspiration, but their inspiratory cranial displacement remained unchanged. The inspiratory outward and caudal displacement of the sternum, the inspiratory EMG activity of the parasternal intercostals, the pattern of breathing, and the arterial blood gases were also unaltered. However, the inspiratory EMG activity recorded from the external intercostals increased consistently to 327 +/- 101% of control (p < 0.05). These observations indicate that with flail chest, the disconnected segment of the rib cage shows paradoxical motion exclusively along the lateral axis; the increased external intercostal activation may account, at least in part, for the persistent inspiratory cranial motion of the ribs. These observations also suggest that the harmful effects of blunt chest injuries are related to pulmonary contusion and pain, rather than to flail chest per se.

Animals↗
PubMedDate not supplied

Stress fracture of the ribs in female rowers.

Stress fractures of the lower ribs related to sports are rare. Fractures of the ribs related to rowing sports have not been reported. We have documented seven cases of stress fractures of the lower ribs in female athletes; four were elite rowers and three were engaged in tennis, golf, and gymnastics. Each athlete was initially seen and treated elsewhere for muscular strain. All athletes presented with pain in the posterolateral thorax in and around the scapula. The time from onset of symptoms to diagnosis ranged from 2 to 6 months. Bone scans were used to document the fractures when roentgenograms were equivocal. Each athlete responded to a 4 to 8 week period of rest or training modification. Biomechanical analysis of the forces across the ribs demonstrates that these fractures tend to occur along the posterolateral segment where the bending stresses on the rib are greatest. The predominant muscle forces are generated by the forced couple of scapular retraction and protraction acting through the serratus anterior. We postulate that inadequate strength and resistance training background in women is the cause for the apparent increased susceptibility of women to these skeletal injuries.

Adult↗
PubMed1982

A comparative study of the chemical analysis of ribs and femurs in Woodland populations.

Parallel chemical analyses of ribs and femurs from the Middle Woodland Gibson site and the Late Woodland Ledders site show that the elements most closely related to diet (strontium, zinc, magnesium) are found in identical proportions in the two bones. Elements associated with soil contamination (iron, aluminum, potassium, manganese) are found in a significantly higher proportion in the rib. The major elements calcium and sodium are found in lower levels in the ribs. Thus the rib is more sensitive to diagenetic processes that alter elemental proportions than is the femur. Conclusions concerning subgroupings by sex or site, derived from the diet-related elements (Sr, Zn, Mg), were found to be essentially the same for the rib and the femur.

Adolescent↗
PubMed1984

Metamorphosis at the sternal rib end: a new method to estimate age at death in white males.

While the pubic symphysis and intracortical morphometry have provided successful results in estimating age at death, other methods and sites in the skeleton are needed to improve the accuracy of age estimation. This research is an attempt to develop a new age-determination technique by using the sternal extremity of the rib. The right fourth rib was collected at autopsy from 93 white males. The sternal extremity of each rib was analyzed in relation to the pit depth (component I), pit shape (component II), and rim and wall configurations (component III), each of which was divided into six stages. Results indicated that the age at death can be estimated from a rib within about 2 years in the second decade to about 7 years in the fifth and sixth decades of life. Pit shape and rim and wall configurations yielded better results than absolute pit depth alone. While this method has a potentially important contribution to skeletal anthropology, factors such as sex differences and biomechanical variation between individuals may affect the determination of age from the rib.

Adolescent↗
PubMed2006

On the trail of pulmonary tuberculosis based on rib lesions: results from the Human Identified Skeletal Collection from the Museu Bocage (Lisbon, Portugal).

In the last 20 years, studies on human identified skeletal collections have revealed a significant relationship between new bone formation on the visceral surface of ribs and pulmonary tuberculosis (TB). To improve methods of differential diagnosis of respiratory diseases in archaeological skeletons, an investigation was conducted on 197 individuals from the Human Identified Skeletal Collection of the Museu Bocage (Lisbon, Portugal). This sample included 109 males and 88 females who lived during the 19th-20th centuries, with ages at death ranging from 13-88 years. The skeletons were grouped according to cause of death: 1) pulmonary TB (N = 84); 2) pulmonary non-TB diseases (N = 49); and 3) a control group (N = 64) composed of individuals randomly selected among the extrapulmonary non-TB causes of death. The ribs, sterna, scapulae, and clavicles were macroscopically observed. New bone formation on the visceral surface of ribs was recorded in 90.5% (76/84) of individuals who died from pulmonary TB, in 36.7% (18/49) with a pulmonary non-TB disease as cause of death, and in 25.0% (16/64) of the control group. These differences were statistically significant (P < 0.001). Furthermore, in individuals with pulmonary TB, the bony lesions presented mainly as lamellar bone on the vertebral end of the upper and middle thoracic rib cage. Proliferative alterations also occurred on one sternum and in nine clavicles and eight scapulae. This work strongly supports the results of similar studies performed on other documented collections, suggesting that new bone formation on ribs, although not pathognomonic, is a useful criterion for the differential diagnosis of pulmonary TB.

Adolescent↗
PubMed1993

Effects of sodium bicarbonate and ammonium chloride on the incidence of furosemide-induced fetal skeletal anomaly, wavy rib, in rats.

Furosemide produces fetal wavy ribs when administered to pregnant rats during late gestation. The compound is also known to produce metabolic alkalosis in laboratory animals and man. In order to evaluate the effect of furosemide on maternal blood pH, Crj:CD(SD) female rats received an oral administration of 150 or 200 mg/kg of furosemide by gavage on day 16 of gestation and were bled at 4 hr post-dose. Compared to an average pH of 7.39 in control females, there was a significant elevation in blood pH in these furosemide-treated females (average pH of 7.44 to 7.48). When 2% sodium bicarbonate was provided in the drinking water for females treated with 150 mg/kg of furosemide, there was a further rise in maternal blood pH (7.52) compared to females treated with furosemide alone. Associated with this elevation in maternal blood pH was a marked increase in the incidence of fetal wavy ribs (87.6% compared to 27.6%). When females treated with 200 mg/kg of furosemide were provided with 0.5% ammonium chloride, furosemide-induced maternal alkalosis was corrected (pH decreased to 7.35) and there was a reduction in the incidence of fetal wavy ribs (7.0% compared to 37.2%). In addition, maternal blood pH among individual females was positively correlated with the incidence of fetal wavy ribs (r = 0.714). These results suggest that maternal metabolic alkalosis is involved in the pathogenesis of furosemide-induced wavy ribs.

Alkalosis↗
PubMed1993

Pleural pressure measured in the zone of apposition of diaphragm to rib cage in rabbits.

In 10 anesthetized adult rabbits, we studied the effect of spontaneous breathing and positive pressure ventilation on pleural pressure on the costal lung surface (Ppl) and in the zone of apposition of the rib cage to the diaphragm (Papp). Ppl and Papp were measured by rib capsules installed in the 5th or 6th rib and 11th or 12th rib, respectively. Esophageal (Pes) and gastric (Pga) pressures were measured with air-filled balloons. At end expiration (functional residual capacity), Ppl was subatmospheric (-2.5 +/- 1.4 cm H2O), decreased during spontaneous inspiration, and was in phase with Pes. In contrast, Papp was above atmospheric pressure (2.1 +/- 1.8 cm H2O), increased during inspiration, and was in phase with Pga. Papp lagged Ppl by 180 degrees during spontaneous inspiration but was in phase with Ppl during mechanical ventilation. Changes in Ppl (delta Ppl) during inspiration were greater in magnitude than either delta Papp or delta Pga. Changes in transdiaphragmatic pressure in the zone of apposition (delta Pga-delta Papp) were near zero (-0.4 +/- 0.3 cm H2O), much smaller in magnitude than those (delta Pga-delta Ppl) associated with the lung (3.0 +/- 1.5 cm H2O). These results are consistent with the concept that during breathing, abdominal pressure is transmitted to the zone of apposition of the rib cage to the abdomen. During spontaneous breathing at rest, the pleural space in the zone of apposition is mechanically independent of the pleural space associated with the lung.

Animals↗
PubMed1991

Stress fracture of the first rib in a weightlifter.

An isolated fracture of the first rib is rare. Stress fractures of the first rib have previously been reported in various sports and the mechanism of fractures of the first rib has been well documented. Stress fractures of the first rib have also been reported in laborers involved in heavy lifting. The course is insidious, and identification of the lesion is usually made on the basis of an incidental roentgenogram. No reported case of stress fracture of the first rib in a weightlifter has hitherto been available. This paper describes such a case for the first time.

Adolescent↗
PubMed2005

Breath-to-breath analysis of abdominal and rib cage motion in surfactant-depleted piglets during high-frequency oscillatory ventilation.

OBJECTIVE: To assess the value of monitoring abdominal and rib cage tidal displacement as an indicator of optimal mean airway pressure (Paw) during high-frequency oscillatory ventilation (HFOV). DESIGN AND SETTING: Prospective observational study in a university research laboratory. ANIMALS: Eight piglets weighing 12.0+/-0.5 kg, surfactant depleted by lung lavage. INTERVENTIONS: Compliance of the respiratory system (C(rs)) was calculated from a quasistatic pressure volume loop. After initiation of HFOV lung volume was recruited by increasing Paw to 40 cmH(2)O. Then mean Paw was decreased in steps until PaO(2)/FIO(2) was below 100 mmHg. Proximal pressure amplitude remained constant. MEASUREMENTS AND RESULTS: Abdominal and rib cage tidal displacement was determined using respiratory inductive plethysmography. During HFOV there was maximum in tidal volume (Vt) in seven of eight piglets. At maximal mean Paw abdominal and rib cage displacement were in phase. Phase difference between abdominal and rib cage displacement increased to a maximum of 178+/-28 degrees at minimum mean Paw. A minimum in abdominal displacement and a maximum of Vt was found near the optimal mean Paw, defined as the lowest mean Paw where shunt fraction is below 0.1. CONCLUSIONS: During HFOV abdominal and rib cage displacement displayed mean Paw dependent asynchrony. Maximal Vt and minimal abdominal displacement coincided with optimal C(rs), oxygenation, and ventilation, suggesting potential clinical relevance of monitoring Vt and abdominal displacement during HFOV.

Abdomen↗
PubMed2004

Abnormalities of the vertebral column and ribs associated with anorectal malformations.

Lumbosacral vertebral abnormalities are a common association of anorectal malformations (ARMs) and are one of the determinants of the eventual level of fecal continence that can be achieved. This study used a fetal rat model to investigate the spectrum of axial skeletal maldevelopment that may occur with ARMs. Time-mated pregnant rats received 125 mg/kg of 1% ethylenethiourea (ETU) (experimental group) or vehicle only (control). Their fetuses were examined for external malformations and prepared for staining of their skeletons using Alcian blue and Alizarin red S. ARMs developed in 67/68 (98%) of ETU-exposed fetuses, of which 28 (42%) also developed rachischisis, mainly involving the lumbosacral vertebrae. No skeletal abnormality was found in control fetuses. ETU-exposed fetuses with ARMs and rachischisis had abnormal ossification of the vertebral centrum, abnormal fusion between the neural arches of vertebrae, localized narrow or interrupted thoracic vertebral canal, a widely open vertebral canal in the lumbosacral area (rachischisis), and absence of the lower two sacral and coccygeal vertebrae. Rib abnormalities included absence of two to three floating ribs, abnormal fusion of adjacent proximal segments, and abnormal ramification, irregularity, and angulation of their distal segments. The vertebral and rib abnormalities found in ETU-exposed fetuses with ARMs but no rachischisis were much less severe. In addition to the lumbosacral anomalies that are common with ARMs, severe abnormalities of the thoracic vertebrae and their corresponding ribs may occur also. Fetuses with both ARM and rachischisis tend to have more extensive and severe vertebral and rib anomalies. These observations imply a possible common aetiology for ARMs and vertebral anomalies and are consistent with our understanding of the perceived role of the notochord in axial development.

Abnormalities, Drug-Induced↗
PubMed1997

Fully thoracoscopic pulmonary lobectomy and specimen extraction through rib segment resection. Preliminary report.

BACKGROUND: A technique of fully thoracoscopic pulmonary lobectomy with rib-segment resection for specimen extraction is described, and preliminary results in 18 patients are presented. METHODS: Surgery is performed through four 15-mm ports. For all lobes except one, the surgeon operates in front of the patient, where the rib spaces are widest and rib-space trauma is less. When lobar dissection is complete, specimen extraction is performed after resection of a rib segment proportional to tumor size. Muscle section is kept to a minimum. There is no rib retraction. RESULTS: There were no deaths, three conversions to open surgery, and three major complications. Average postoperative stay was 5.4 days for patients without complications and 9.6 days for patients with complications. In total six patients presented with some degree of air leaks, and two had post-thoracotomy pain (>2 month's duration). The literature is reviewed to analyze current techniques and to define parameters of a truly minimally invasive pulmonary lobectomy. CONCLUSIONS: This technique is safe and promising; however, thoracoscopic lobectomy still needs refining. Before valid randomized studies comparing thoracoscopic lobectomy and muscle-sparing thoracotomy or posterolateral thoracotomy can be credible, technical issues related to the production of a truly minimally invasive procedure should be resolved.

Cohort Studies↗
PubMed1999

A biomechanical analysis of the vertebral and rib deformities in structural scoliosis.

Although the structural changes occurring in the scoliotic spine have been reported as early as the 19th century, the descriptions and biomechanical explanations have not always been complete and consistent. In this study, three-dimensionally rendered CT images of two human skeletons with a scoliotic deformity and two patients with serious scoliosis were used to describe the intrinsic vertebral and rib deformities. The pattern of structural deformities was found to be consistent. Apart from the wedge deformation of the apical vertebrae, a rotation deformity was found in the transversal plane between the vertebral body and the posterior complex: the vertebral body was maximally rotated towards the convexity of the scoliotic curve, whereas the tip of the spinous process was pointed to posterior. The rib deformities at the convex side of the scoliotic curve showed an increased angulation of the rib at the posterior angle, whereas the rib curve on the concave side was flattened. The observed vertebral deformities suggest that these are caused by bone remodelling processes due to forces in the anterior spinal column, which drive the apical vertebral body out of the midline, whereas forces of the musculo-ligamentous structures at the posterior side of the spinal column attempt to minimize the deviations and rotations of the vertebrae. The demonstrated rib deformities suggest an adaptation to forces imposed by the scoliotic spine.

Biomechanical Phenomena↗