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 the 8th to 10th ribs (also known as 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:

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:

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:

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

On the basis of your exam, an x-ray, ultrasound, MRI or blood tests may be done to check for 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.

Your provider may also prescribe pain medicines to relieve pain.

You may be asked to:

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. Injections or surgery may be required in some cases.

Possible Complications

Complications may include:

There are usually no long-term complications.

When to Contact a Medical Professional

You should contact your provider right away if you have:

Call 911 or the local emergency number if:

References

Cupit GL, Dixit S, Chang CJ. Thorax and abdominal injuries. In: Madden CC, Putukian M, McCarty EC, Young CC, eds. Netter's Sports Medicine. 3rd ed. Philadelphia, PA: Elsevier; 2023:chap 52.

Kolinski JM. Chest pain. In: Kliegman RM, Toth H, Bordini BJ, Basel D, eds. Nelson Pediatric Symptom-Based Diagnosis. 2nd ed. Philadelphia, PA: Elsevier; 2023:chap 8.

McMahon, LE. Slipping rib syndrome: a review of evaluation, diagnosis and treatment. Semin Pediatr Surg. 2018;27(3):183-188. PMID: 30078490 pubmed.ncbi.nlm.nih.gov/30078490/.

Waldmann SD. Slipping rib syndrome. In: Waldmann SD, ed. Atlas of Uncommon Pain Syndromes. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 72.


Review Date: 10/15/2023
Reviewed By: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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