Chest Wall Conditions
Slipped Rib Syndrome: Why It Is So Often Missed
Slipped rib syndrome is one of the most consistently under-diagnosed conditions in thoracic medicine. Many patients spend years being investigated for gastrointestinal, spinal, or musculoskeletal causes before the correct diagnosis is reached.
The condition arises from the lower ribs — the 8th, 9th, and 10th — which are joined by fibrocartilaginous tissue that can loosen, allowing adjacent ribs to overlap and catch. The resulting pain is typically felt in the lower chest, worsened by twisting, reaching overhead, or deep breathing.
The "hooking manoeuvre" establishes the diagnosis at the bedside. Where surgery is right, keyhole rib resection achieves pain relief in over 80% of patients.
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Lung Cancer & Nodules
A Lung Nodule on Your CT Scan: What It Means and What Happens Next
The vast majority of lung nodules are benign. However, a proportion are early lung cancers, and the size, shape, and density provide important clues about likelihood of malignancy.
Robotic navigational bronchoscopy has transformed the diagnostic pathway — a robotic catheter uses a real-time 3D map to navigate to peripheral nodules, obtaining a tissue sample without surgical incision.
Five-year survival for Stage I lung cancer treated surgically exceeds 80%. The earlier the surgery, the less lung tissue removed and the faster the recovery.
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Diaphragm Conditions
Diaphragm Paralysis: A Frequently Missed Cause of Breathlessness
The diaphragm accounts for approximately 70% of the work of breathing at rest. When paralysed — often after cardiac surgery, trauma, or tumour — the resulting breathlessness can be severe and disabling.
A key feature is breathlessness markedly worse when lying flat, bending forward, or swimming — symptoms frequently attributed to other causes for months or years.
Diaphragmatic plication — keyhole tightening of the weakened diaphragm — restores mechanical function and improves breathlessness in the majority of patients.
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Hyperhidrosis
Hyperhidrosis: When Excessive Sweating Becomes a Surgical Problem
Primary hyperhidrosis affects an estimated 1–3% of the population. For many it is genuinely life-limiting — caused by overactivity of the sympathetic nervous system.
Endoscopic thoracic sympathectomy (ETS) is keyhole surgery that divides the relevant sympathetic chain through a single small incision. Success rates above 95% for palmar sweating. Most patients go home the same day.
Full discussion of risks and expected outcomes — including compensatory sweating — is always provided before any decision is made.
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