In this article, we look at the causes and symptoms of slipping rib syndrome, as well as when to see a doctor.
What is slipping rib syndrome?
Slipping rib syndrome occurs when a person's ribs slip and move.
Slipping rib syndrome occurs when the ligaments holding the ribs in place move, cause the ribs to shift or "slip."
Slipping rib syndrome is more likely to occur in women than men. Playing contact sports is also a risk factor.
It usually affects the eighth, ninth, or tenth ribs, as these lower ribs are not connected to the mid-chest bone.
Instead, they are connected to each other by fibrous tissue or ligaments, which allows for greater movement and flexibility of the lower chest region. If these ligaments are injured or weakened, the damage can cause the ribs to slip.
When slipping rib syndrome occurs, the movement can irritate the nerves and put a strain on specific muscles in the affected area. The result is inflammation and pain.
The most common symptoms of slipping rib syndrome are:
- back pain
- abdominal pain that can come and go
- abdominal pain that is initially sharp and intense before fading to a dull ache
- "popping" or "clicking" feelings, or the sensation that the rib is slipping
- difficulty breathing properly
A person will also usually experience pain when undertaking particular activities that involve movement of the rib cage. Examples include bending and lifting, breathing deeply or coughing, stretching, going up stairs, getting up from a seated position, and rolling over in bed.
In most instances, a rib only slips on one side, though it is possible for slipping rib syndrome to occur on both sides of the ribcage at the same time.
Asthma is a possible cause for slipping rib syndrome.
There are many possible reasons why slipping rib syndrome might occur, but sometimes there is no precise cause. In most cases, slipping rib syndrome occurs due to other problems in the chest, such as a weakness in chest muscles or ligaments.
Weakness in the chest muscles or ligaments is often due to hypermobility of the eighth, ninth, and tenth ribs. Hypermobility means they are more likely to move. These ribs are also more susceptible to trauma and injury.
Other causes of slipping rib syndrome are:
- weak or fragile ligaments around the ribs
- 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, therefore a doctor may do several tests to rule these out.
A doctor will ask about a person's symptoms and medical history, including how long the symptoms have been happening and if anything makes them worse.
A doctor may perform a test called the hooking maneuver to help diagnose slipping rib syndrome.
The test involves the doctor hooking their fingers under the person's rib margins and moving them upward and back. If this causes discomfort, the doctor may be able to diagnose slipping rib syndrome without any further tests.
Other possible conditions with similar symptoms include:
- cholecystitis or inflammation of the gallbladder
- hepatosplenic abnormalities
- inflammation of the chondral cartilage
- esophagitis or inflammation or irritation of the esophagus
- gastric ulcers
- stress fractures
- muscle tears
- pleuritic chest pain
- costochondritis or Tietze syndrome
- various heart conditions
- cancer of the bone, but this is rare
Botulinum toxin injections may be used for pain relief.
Treatment will depend on the severity of someone's pain and discomfort. If these are mild to moderate, the following treatment methods may be suggested:
- hot and cold alternative compression
- stretch and rotation exercises
- non-steroidal anti-inflammatory drugs (NSAIDs) for the pain.
- resting and avoiding strenuous activity
Using over-the-counter pain medications is not seen as a long-term treatment and may cause side effects, including gastritis.
Medical treatments for slipping rib syndrome include:
- A corticosteroid injection to help reduce the swelling in the affected area.
- Botulinum toxin treatment, involving an injection into the muscles around the rib cage for pain relief.
- Prolotherapy, where nerve endings are stimulated to promote the body's natural healing process.
- Ultrasound therapy, involving blocking the nerve endings to lessen muscle-swelling and encourage rib mobilization.
Alternative natural treatments are also thought to provide some relief to people with slipping rib syndrome. These include:
- Breathing Exercises: Breathing in deeply and holding for 10–15 seconds before slowly releasing can increase the rib mobilization.
- Pressure exercises: Careful pressure on the chest wall is applied, as the person breathes in deeply and exhales slowly. This should be done under a doctor's supervision.
- Expansion of chest muscles: A person stands or sits with a straight back and pushes their shoulders backward, squeezing them together to expand the chest muscles. They then pull their shoulders forward, squeezing them together to compress the chest muscles.
A person should consult a doctor before starting these exercises to ensure they are done correctly, and they will not make the symptoms worse.
In some cases, slipping rib syndrome requires surgery. This intervention is usually recommended for people with severe and continuous pain if other options have not helped.
The surgical procedure is known as costal cartilage excision.
When to see a doctor
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.