For GPs, emergency and acute medicine teams, physiotherapists, osteopaths, sports and
exercise medicine clinicians, and solicitors’ case managers. One secure route, a prompt reply, and a
plan you can act on.
New patients are usually seen within a week, and acute rib fracture cases sooner. Clinic letters go to the
referrer and the patient. NHS referrals to the thoracic surgery service at Hammersmith Hospital, Imperial
College Healthcare NHS Trust, go through the NHS e-Referral Service in the usual way.
Who to refer
When a chest wall opinion changes the plan
Acute (days)
Three or more rib fractures, or any displaced fracture
Any rib fracture in a patient over 65particularly on anticoagulants or with COPD, heart failure or frailty
Flail segment, or fractures with respiratory compromise
Sternal fracture
Pain not controlled within 48 to 72 hours on standard analgesia
Rib fractures in an athlete or manual worker who needs a defined return plan
Chest wall injury with a normal X-ray but persistent focal paincartilage injuries do not show on X-ray
Persistent (weeks to months)
Chest wall pain more than six to eight weeks after injury
Suspected non-unioncrepitus, a step, or a lump at an old fracture
Clicking, popping or slipping lower ribsslipping rib syndrome
Chronic anterior chest wall pain labelled costochondritis that has not settled
Chest wall pain with a completed, normal cardiac and gastrointestinal work-up
Burning, band-like pain suggesting intercostal neuralgiaincluding post-surgical and post-herpetic
Xiphoid tenderness, chest wall lumps, bulges that appear on straining, and chest wall shape concerns
What to include
Enough to triage — a short referral is fine
Mechanism and date of injury, or duration of symptoms
Imaging already done, with reports; CT and ultrasound images can be attached or transferred via the image exchange portal
Current analgesia and what has been tried
Anticoagulants and antiplatelets, relevant comorbidities (particularly lung disease, diabetes, osteoporosis, steroid use) and smoking status
For private patients: insurer and authorisation number, or self-pay
GP details, and the physiotherapist or club doctor you would like copied in
A short referral is fine. If the case is urgent, a phone call is better than a perfect letter.
What happens next
From referral to a written plan
Acknowledgement
From the practice, with an appointment offer.
Same day
Consultation
History, hands-on chest wall examination, review of imaging. Where imaging will change the plan — thin-slice CT with 3D reconstruction, dynamic ultrasound, MRI for stress fractures — it is arranged on the same visit wherever possible.
Within a week
Diagnostic or therapeutic nerve block
Under ultrasound guidance, where indicated.
Same visit
A written plan to you and the patient
Diagnosis, treatment, rehabilitation, and who does what.
After the visit
Rehabilitation goes back to you. Referring physiotherapists and osteopaths keep their patients; the plan is
written to be delivered locally, with direct access to the practice for questions.
What the practice offers
Diagnosis and treatment under one chest wall service
Assessment of chest wall lumps, including image-guided biopsy
Treatment
Surgical stabilisation of rib fractures (rib plating), acute and delayed
Non-union repair and resection
Slipping rib syndrome surgery
Costal cartilage repair
Sternal fixation and xiphoidectomy
Intercostal nerve decompression and neurectomy
Chest wall hernia repair
Excision of chest wall lumps
Rib flare and pectus assessment
Where patients are seen
Five private hospitals, plus NHS care at Hammersmith
Private consultations and surgery at the Cromwell Hospital, the Wellington Hospital, the London Clinic,
HCA Elstree and Imperial Private Healthcare. NHS care at Hammersmith Hospital. Video consultations are
available for follow-up and for patients travelling from outside London.
Mr Scarci is recognised by the major UK private medical insurers. Self-pay consultation and procedure
fees are available on request from the practice.
The most useful thing a surgeon can do is confirm the diagnosis
Ruling out the things that will not respond to rehabilitation — a non-union, a separated cartilage,
a slipping rib, or a trapped nerve — is where a chest wall opinion earns its place.
Physio & osteo
Physiotherapists & osteopaths
Refer directly, without a GP letter for private patients. Your patient comes back with a diagnosis, imaging, and a plan that includes what to load and when. For athletes, return-to-sport planning is done jointly with club and team clinicians.
Legal
Solicitors & case managers
Treating-clinician referrals after road traffic accidents and accidents at work, through the same routes. Treatment reports and imaging are provided promptly for case management. Expert witness instructions go to the medicolegal practice, not this page.
Teaching
Talks & teaching
Practice-based sessions for GP practices, physiotherapy teams and sports clubs — rib fractures in older adults, slipping rib syndrome, and chest wall pain that outlasts the tests. Arranged through the practice.
Mr Scarci holds an NHS consultant post at Hammersmith Hospital, Imperial College Healthcare NHS Trust, and
runs a chest wall practice across London’s leading private hospitals. He has performed more than 5,000
procedures at consultant level since 2011 and treats rib and chest wall injuries every week, from acute
trauma to the long-standing pain that other tests have failed to explain.
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