THE 12TH RIB SYNDROME

The twelfth rib syndrome appears to be a fairly common and underdiagno sed chronic pain syndrome. It is more common in women than men (3:1) a nd is usually described as a constant dull ache or sharp stabbing pain that may last from several hours to many weeks. Lateral flexion, rota tion of the trunk, and rising from a sitting position classically aggr avate the pain. Manipulation of the affected rib and its costal cartil age reproduces it exactly. The diagnosis of this syndrome is clinical, requires exclusion of specific etiologies, and should only be made wh en, the patient symptoms can be exactly reproduced by manipulation of the affected rib. If symptomatology is complicated it may be necessary to we an image intensifier for accurate location of the pain locus. P atients with this syndrome can be overinvestigated and have even under gone surgical procedures when this diagnosis has been overlooked. To d escribe the varied presentation of this syndrome, we describe the clin ical manifestations in six patients. (C) U.S. Cancer Pain Relief Commi ttee, 1997.