Slipping rib syndrome is a condition where the lower ribs slip away from their usual position. It occurs because of a defect or hypermobility in the cartilage that connects the ribs to the rib cage.

Slipping rib syndrome can cause a person to feel pain in their abdomen, lower chest, and lower back. The condition is rare, and it can often be difficult to diagnose.

This article looks at the causes and symptoms of slipping rib syndrome and when to contact a doctor.

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Slipping rib syndrome occurs when the ligaments around the ribs move, causing the ribs to shift or “slip.”

It usually affects the eighth, ninth, or tenth ribs, also known as false ribs. These ribs do not join the sternum directly. However, they connect to the seventh rib via fibrous tissue or ligaments.

This connection allows for greater movement and flexibility of the lower chest region. If this cartilage sustains damage or becomes weak, the ribs may slip.

When slipping rib syndrome occurs, the movement can irritate the nerves and strain muscles in the affected area. The result is inflammation and pain.

The most common symptoms of slipping rib syndrome are:

  • back pain
  • abdominal pain
  • pain in the middle of the chest
  • pain in a person’s side
  • pain in the back of the ribs
  • “popping” or “clicking” feelings, or the sensation that the rib is slipping
  • difficulty breathing due to pain during rib cage expansion and contraction

In most instances, a rib only slips on one side, though it is possible for slipping rib syndrome to occur simultaneously on both sides of the ribcage.

Complications

Slipping rib syndrome can cause chronic, recurring pain. This may affect a person’s ability to sleep properly and impair their daily lives.

Additionally, if the condition affects a person’s breathing, they may not be able to engage in exercise or may find day-to-day activity difficult.

Slipping rib syndrome occurs when intercostal cartilage between the ribs weakens and allows movement. This movement is often known as hypermobility.

Movement of the cartilage may occur due to physical damage, congenital anomaly, or be of unknown origin. Congenital anomalies are conditions that a person has from birth.

Conditions that may cause ribs to slip include:

  • direct trauma
  • indirect trauma from twisting, or jerking movements
  • muscle tissue attached to the ligaments degenerating
  • a severe and continuous cough

Many of the symptoms of slipping rib syndrome are similar to those of other conditions. This means that a doctor may order several tests before confirming the diagnosis.

A doctor will ask about a person’s symptoms and medical history and may perform a hooking maneuver test. The test involves the doctor hooking their fingers under the person’s rib margins and moving them upward and back.

If manipulating the ribs in this way reproduces the patient’s pain, the doctor may diagnose slipping rib syndrome.

A 2019 study found that dynamic ultrasounds can diagnose slipping rib syndrome in most cases. This form of assessment can also give medical professionals information on other ribs and risks in the surrounding areas.

As slipping rib syndrome causes general pain and discomfort, people may mistake it for other conditions with similar symptoms. These may include:

Slipping rib symptoms may disappear on their own. However, if the condition impacts a person’s daily life, they may require additional treatment. Treatment will depend on the severity of someone’s pain and discomfort.

Oral medications

Doctors will often initially recommend nonsteroidal anti-inflammatory drugs (NSAIDs) to treat pain from slipped ribs.

In some cases, a person may also be able to reduce mild pain from a slipped rib with over-the-counter medications.

Medical treatments

Other treatments for slipping rib syndrome include:

  • corticosteroid injections
  • local anesthetic injections
  • nerve blocks
  • manipulation of the ribs into place

Surgery

If the condition causes continuous or severe pain, and if other treatments are ineffective, a person will require surgery. This is the only option to definitively cure slipping ribs.

The surgical procedure is known as costal cartilage excision or resection. This procedure involves removing cartilage that is causing pain and discomfort in the chest.

A 2020 analysis found that costal cartilage excision and resection resolved symptoms in most cases.

Alternative treatments

Some people may be able to manage their symptoms with noninvasive treatments and management techniques. These can include:

It is essential to seek immediate medical attention if a person experiences intense chest pain or difficulty breathing. These could be signs of a serious or life threatening medical emergency, such as a heart attack.

If pain is ongoing, causing discomfort, and affecting daily activities, a person should visit their doctor as soon as possible. As the symptoms of slipping rib syndrome are similar to other, more severe conditions, it is vital to get a proper diagnosis and start treatment quickly.

What is the outlook for people with slipping rib syndrome?

The outlook for most people with slipping rib syndrome is positive. Many cases will resolve with rest and physical management. Surgical interventions are minimally invasive and typically produce positive results.

What activities should people with slipping rib syndrome avoid?

A person will also usually experience pain when undertaking particular activities involving the rib cage movement. Examples include bending, heavy lifting, pulling, and pushing.

Avoiding these activities and other strenuous forms of exercise may help reduce pain.

What are the other names for slipping rib syndrome?

Other names for slipping rib syndrome include:

  • twelfth rib
  • rib-tip syndrome
  • nerve nipping
  • clicking rib
  • interchondral subluxation
  • costal margin syndrome

Slipping rib syndrome occurs when one, or some, of a person’s lower ribs move out of place. This displacement can affect nerve endings and soft tissue in the surrounding areas. This can cause pain, discomfort, and difficulty breathing.

Symptoms may resolve independently. However, several treatment options are available should slipping rib syndrome cause significant pain. Treatment options involve physical therapy, oral medications, painkilling injections, and surgical intervention.

The outlook for people with slipping rib syndrome is typically good, and long-term management is possible.