What is slipping rib syndrome?
Slipping rib syndrome occurs when the cartilage on a person’s lower ribs slips and moves, leading to pain in their chest or upper abdomen. Slipping rib syndrome goes by many names, including clicking rib, displaced ribs, rib tip syndrome, nerve nipping, painful rib syndrome, and interchondral subluxation, among others.
The condition is slightly more common in women than men. It’s been reported in people as young as 12 years and as old as mid-80s, but it mostly affects middle-aged people. Overall, the syndrome is considered rare.
The symptoms of slipping rib syndrome vary from person to person. In general, the symptoms are described as:
- intermittent sharp stabbing pain in the upper abdomen or back, followed by a dull, achy sensation
- slipping, popping, or clicking sensations in the lower ribs
- difficulty breathing
- worsening of symptoms when bending, lifting, coughing, sneezing, deep breathing, stretching, or turning in bed
Most cases of slipping rib syndrome occur on one side (unilateral), but the condition has been reported to occur on both sides of the ribcage (bilateral).
Visit a doctor right away if you have trouble breathing or have intense chest pain, as this can indicate something more serious, such as a heart attack.
The exact cause of slipping rib syndrome isn’t well understood. Slipping rib syndrome might occur after a trauma, injury, or surgery, but cases have been reported without any notable injuries.
It’s believed to be a result of hypermobility of the rib cartilage (costochondral) or ligaments, particularly ribs 8, 9, and 10. These three ribs aren’t connected to the sternum, but rather connected to each other by loose fibrous tissue. They are sometimes called false ribs. Because of this, they’re most susceptible to trauma, injury, or hypermobility.
This slippage or movement irritates the nerves and may strain certain muscles in the area, leading to inflammation and pain.
Slipping rib syndrome is difficult to diagnose because the symptoms resemble other conditions. A doctor will first take a medical history and ask about your symptoms, including when they started and if anything you do makes them worse. Your doctor will want to know about the activities you participate in and what you were doing right before you started experiencing the chest or abdominal pain.
There’s a test called the hooking maneuver that helps diagnose slipping rib syndrome. To perform this test, your doctor hooks their fingers under the rib margins and moves them upward and back.
If this test is positive and causes the same discomfort, then your doctor usually won’t need to do any additional tests such as an X-ray or MRI scan. This process is called a differential diagnosis.
Other possible conditions that your doctor will want to rule out include:
- gastric ulcers
- stress fractures
- muscle tears
- pleuritic chest pain
- costochondritis, or Tietze syndrome
- heart conditions
- bone metastases
Your doctor may refer you to a specialist for further evaluation. The specialist might ask you to move certain parts of your body or maintain certain postures to look for an association between them and the intensity of your pain.
In some people, the pain can become severe enough to cause disability. Simple actions like turning to the other side while sleeping or wearing a bra can be too painful.
Slipping rib syndrome doesn’t progress to harm anything internally.
In some cases, slipping rib syndrome resolves on its own without treatment. Home treatment may include:
- avoiding strenuous activities
- applying heat or ice to the affected area
- taking a painkiller like acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Advil, Motrin IB) or naproxen (Aleve)
- doing stretching and rotation exercises
If the pain continues despite taking a painkiller, your doctor might try:
- a corticosteroid injection to help reduce the swelling
- an intercostal nerve block (an injection of an anesthetic in the intercostal nerve) to relieve pain
- physical therapy
If the condition persists or causes severe pain, surgery may be recommended. The procedure, known as costal cartilage excision, has been shown in clinical studies to be an effective treatment for slipping rib syndrome.
Slipping rib syndrome doesn’t result in any long-term damage or affect internal organs. The condition sometimes goes away on its own without treatment.
In more severe cases, a single intercostal nerve block can deliver permanent relief for some, but surgery may be needed if the pain is debilitating or doesn’t go away. Case studies have shown positive results after surgery, but only a few cases have been published.