Slipping rib syndrome

Definition

Slipping rib syndrome refers to pain in your lower chest or upper abdomen which may be present when your lower ribs move a little more than normal.

Your ribs are the bones in your chest that wrap around your upper body. They connect your breastbone to your spine.

Alternative Names

Interchondral subluxation; Clicking rib syndrome; Slipping-rib-cartilage syndrome; Painful rib syndrome; Twelfth rib syndrome; Displaced ribs; Rib-tip syndrome; Rib subluxation; Chest pain-slipping rib

Causes

This syndrome usually occurs in 8th to 10th ribs (also known are false ribs) at the lower part of your rib cage. These ribs are not connected to the chest bone (sternum). Fibrous tissue (ligaments), connect these ribs to each other to help keep them stable. The relative weakness in the ligaments can allow the ribs to move a little more than normal and cause pain.

The condition can occur as a result of:

• Injury to the chest while playing contact sports such as football, ice hockey, wrestling, and rugby
• A fall or direct trauma to your chest
• Rapid twisting, pushing, or lifting motions, such as throwing a ball or swimming

When the ribs shift, they press on the surrounding muscles, nerves, and other tissues. This causes pain and inflammation in the area.

Slipping rib syndrome can occur at any age, but it is more common in middle-aged adults. Females may be more affected than males.

Symptoms

The condition usually occurs on one side. Rarely, it may occur on both sides. Symptoms include:

• Severe pain in the lower chest or upper abdomen. The pain may come and go and get better with time.
• A popping, clicking, or slipping sensation.
• Pain when applying pressure to the affected area.
• Coughing, laughing, lifting, twisting, and bending may make the pain worse.

Exams and tests

The symptoms of slipping rib syndrome are similar to other medical conditions. This makes the condition difficult to diagnose.

Your health care provider will take your medical history and ask about your symptoms. You will be asked questions such as:

• How did the pain start? Was there an injury?
• What makes your pain worse?
• Does anything help relieve the pain?

Your provider will perform a physical exam. The hooking maneuver test may be done to confirm the diagnosis. In this test:

• You will be asked to lie on your back.
• Your provider will hook their fingers under the lower ribs and pull them outward.
• Pain and a clicking sensation confirms the condition.

On the basis of your exam, an x-ray, ultrasound, MRI or blood tests may be done to rule out other conditions.

Treatment

The pain usually goes away in few weeks.

Treatment focuses on relieving the pain. If the pain is mild, you can use ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn) for pain relief. You can buy these pain medicines at the store.

• Talk with your provider before using these medicines if you have heart disease, high blood pressure, kidney disease, liver disease, or have had stomach ulcers or internal bleeding in the past.
• Take the dose as advised by the provider. DO NOT take more than the amount recommended on the bottle. Carefully read the warnings on the label before taking any medicine.

Your provider may also prescribe pain medicines to relieve pain.

You may be asked to:

• Apply heat or ice at the site of pain
• Avoid activities that makes the pain worse, such as heavy lifting, twisting, pushing, and pulling
• Wear a chest binder to stabilize the ribs
• Consult a physical therapist

For severe pain, your provider may give you a corticosteroid injection at the site of pain.

If the pain persists, surgery may be done to remove the cartilage and lower ribs, although it is not a commonly performed procedure.

Outlook (prognosis)

The pain often goes away completely over time, although the pain may become chronic. Injection or surgery may be required in some cases.

Possible Complications

Complications may include:

• Difficulty breathing.
• Injury during an injection may cause pneumothorax.

There are usually no long-term complications.

When to Contact a Medical Professional

You should call your provider right away if you have:

• An injury to your chest
• Pain in your lower chest or upper abdomen
• Difficulty breathing or shortness of breath
• Pain during daily activities

Call 911 if:

• You have sudden crushing, squeezing, tightening, or pressure in your chest.
• Pain spreads (radiates) to your jaw, left arm, or between your shoulder blades.
• You have nausea, dizziness, sweating, a racing heart, or shortness of breath.

References

Dixit S, Chang CJ. Thorax and abdominal injuries. In: Madden CC, Putukian M, McCarty EC, Young CC, eds. Netter's Sports Medicine. 2nd ed. Philadelphia, PA: Elsevier; 2018:chap 52.

Kolinski JM. Chest pain. In: Kliegman RM, Lye PS, Bordini BJ, Toth H, Basel D, eds. Nelson Pediatric Symptom-Based Diagnosis. Philadelphia, PA: Elsevier; 2018:chap 7.

McMahon, LE. Slipping rib syndrome: A review of evaluation, diagnosis and treatment. Seminars in Pediatric Surgery. 2018;27(3):183-188.

Waldmann SD. Slipping rib syndrome. In: Waldmann SD, ed. Atlas of Uncommon Pain Syndromes. 3rd ed. Philadelphia, PA: Elsevier; 2020:chap 72.

Waldmann SD. The hooking maneuver test for slipping rib syndrome. In: Waldmann SD, ed. Physical Diagnosis of Pain: An Atlas of Signs and Symptoms. 3rd ed. St Louis, MO: Elsevier; 2016:chap 133.