Introduction
The rib bones are the skeletal framework of the chest encompassing the lungs and other organs in the chest cavity. Anatomically there are twelve pairs of ribs present. These ribs are classified into three types based on their attachment to the sternal bone (the center flat bone of the chest to which the ribs are attached) true, false, and floating ribs. The true ribs are the first seven ribs of the ribcage, which directly articulates itself with the sternum. The false ribs are the eighth, ninth, and tenth rib bones, which indirectly articulate themselves with the sternal bone through the costochondral cartilages. The eleventh and the twelfth ribs are called the floating ribs as they arise from the vertebral column and do not attach themselves to the sternal bone, making them look like floating bones. The purpose of the floating ribs is that as it remains unattached to the sternum, it allows the expansion of the diaphragm during breathing. However, these ribs are prone to fracture easily because of their disengagement to the anterior sternum, and because of this reason, these floating ribs are also known as vertebral ribs.
What Is the Anatomy of Rib Bone?
Most of the ribs present are typical and have the following structural anatomy. The parts are:
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A head with four articulating surfaces.
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Neck.
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Tubercle of the bone
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Bone Shaft
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Coastal groove.
While there are a few other ribs, called atypical ribs, which do not possess all the following features, those ribs are the first, second, tenth, eleventh, and twelfth ribs (floating ribs). The eleventh and the twelfth ribs, or the floating ribs, show no neck with only one articulating surface. The vascular supply of floating ribs varies from that of the normal ribs as they are short and remain unattached. These ribs receive their blood supply from the posterior intercostal arteries for the eleventh and twelfth ribs by subcostal arteries and veins. The intercostal nerves give the sensory and motor nerve supply.
What Are the Functions of the Ribs?
The ribs' functions are crucial as they protect the contents in the chest cavity, including the heart and lungs.
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They constantly expand and retract to facilitate breathing.
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Serves as a site for muscle origination and attachment.
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It acts as a site of blood cell production during child development.
What Is Floating Rib Syndrome?
Slipping or floating rib syndrome is a painful condition where a patient experiences pain in the lower chest or upper abdomen when an abnormal movement moves the ribs due to a loss in cartilaginous connection. Floating rib syndrome is very common and involves the eighth to twelfth ribs involving the false and floating ribs. The cause of the condition can be direct or indirect and commonly occurs due to trauma, direct fall injury, sports injuries, sudden twist and turn motions, and other causes due to intrauterine developmental defects.
How Commonly Is Floating Rib Syndrome Seen?
Floating rib syndrome affects people of all age groups but predominantly in middle-aged and older adults. The condition also shows a higher female incidence than male patients.
What Are the Symptoms of Floating Rib Syndrome?
Patients experience a deep, dull, continuous throbbing pain at the bottom of the chest and upper abdomen. There is a palpable accumulation of fluid in the diaphragm area. A popping or clicking sound or sensation is felt at the site of injury. Normal body movements like coughing or laughing while lifting a thing, twist and turn movements, and bending can aggravate the pain often.
How Is Floating Rib Syndrome Evaluated?
After clinically observing, floating rib syndrome is evaluated through a few diagnostic tests to confirm the condition. It can be assessed by laboratory and imaging tests, and they include:
Radiographic Imaging (X-rays): X-rays are two-dimensional imaging techniques used to evaluate any bony fracture or lesion. Chest X-rays are taken to evaluate the condition of the rib bones and to rule out any lesions.
Ultrasound Imaging: Ultrasound is an imaging technique used to record the body using sound waves. The ultrasound images are taken by running the wand around the chest region to detect the presence of blood or any fluid and rule out the puncture of any organ inside.
Computed Tomography (CT): CT scans are three-dimensional imaging techniques used to clarify the affected area in a three-dimensional view.
Magnetic Resonance Imaging (MRI): MRI is an imaging method that helps in studying the structures and soft tissue associated with the rib bones. Here magnetic resonance imaging or MRI is taken to study the adjacent muscles and soft tissues related to the rib cage.
Blood Test: Blood tests are taken to check for any inflammatory markers like an increase in white blood cell count.
How Is Floating Rib Syndrome Treated?
The first line of treatment is pain management, where the patient is put on non-steroidal painkillers along with hot or cold compression and rest. The pain usually subsides by itself after a sudden strenuous injury. In case of severe injuries, chest binders are used for stabilizing the ribs, compulsory rest is advised, and physiotherapy is given for pain relief. Steroid injections are also given intra-muscularly at the site of injury to relieve pain. Although intense pain, it usually subsides over a given period and is easily manageable. If persistent, rare surgery is considered.
Conclusion
Floating ribs are often overlooked pairs of ribs because of the structure and injuries to the floating ribs or the eleventh and twelfth ribs. When not detected, it may result in severe painful conditions. Although the pain is regressive, floating ribs are more easily prone to injury because of their lack of attachment to the sternum. The floating bones are weak and can easily fracture during a fall, but the crucial part is the organs engaged by these ribs, as they can result in deleterious aftereffects. So it is always important to immediately seek medical help in case of any pain or injury in the lower chest or upper abdomen area to rule out injury to the floating rib bone.
