Published on Sep 19, 2018 and last reviewed on Mar 28, 2020 - 3 min read
Slipping rib syndrome, also referred to as slipped rib syndrome, clicking rib syndrome, displaced ribs, painful rib syndrome, rib tip syndrome, intercostal subluxation, etc., is a rare condition where the ribs slip from their normal position due to the movement of the ligaments causing abdominal pain or back pain.
This condition affects women slightly more than men. It is a rare syndrome and can affect persons of any age group following a trauma or surgery. The ribs involved are the eighth, ninth, and tenth ribs as they are not connected to the central chest bone but to each other by loose tissues and ligaments. Although this allows for more flexibility and movement, it also makes these ribs more prone to slipping in case of an injury or blow.
Slipping rib syndrome can result in symptoms that vary from one person to another. The common symptoms include:
Sharp and intermittent stabbing type of pain in the upper abdomen or back. This pain is followed by a dull and achy feeling.
Sensations of the lower ribs slipping or popping.
These symptoms worsen on bending, coughing, lifting heavy objects, sneezing, stretching, deep breathing, etc. In most cases, only one side gets affected, but it can affect both sides. Consult a doctor immediately if you experience breathing problems or chest pain, as these are also signs of a heart attack.
There are various causes of slipping rib syndrome, which includes:
Weakness in chest muscles or ligaments - this is because of hypermobility of the eighth, ninth, and tenth ribs.
Trauma or injury to the ribs.
Degeneration of muscle tissue that are attached to the ligaments.
Severe and persistent cough.
The doctor, after taking a thorough history, will perform the 'hooking maneuver' test to confirm the slipping rib syndrome. In this test, the doctor will hook his fingers under the patient's last rib and make an upwards and backward movement. If this action causes pain, then a diagnosis is made.
As many other conditions can result in similar symptoms, the doctor will try to rule out these conditions with the help of some tests.
Some other conditions that result in similar symptoms are:
Problems in the sleep and liver.
Cholecystitis (inflammation of the gallbladder).
Costochondritis (inflammation of the chondral cartilage).
Esophagitis (inflammation of the esophagus).
Some heart problems.
There are various treatment options depending on the severity of pain and discomfort. For mild to moderate symptoms, the treatment options include:
Hot and cold compression - Apply hot and cold compressions alternatively for 3 to 4 times a day. This will help relieve pain.
Stretch and rotation exercises.
Physiotherapy - Consult a trained physiotherapist to learn proper physical therapy methods.
Painkillers such as non-steroidal anti-inflammatory drugs (NSAIDs).
Take plenty of rest.
Avoid all strenuous activities.
The treatment options for severe cases include:
Corticosteroid injections - Corticosteroids are injected in the site of pain, which helps reduce swelling.
Botulinum toxin (Botox) - Botox is injected into the muscles surrounding the rib cage. This relieves pain.
Ultrasound therapy - The nerve endings are blocked in order to reduce swelling and promote rib mobilization.
Prolotherapy - Here, nerve endings are stimulated, which promotes the natural healing process of the body.
Taking a deep breath and then releasing your breath slowly after holding it for 10 to 15 seconds will increase rib mobilization.
A doctor will carefully apply pressure on your chest wall and ask you to take deep breaths.
The patient sits or stands straight and pushes his or her shoulder back. This expands the chest muscles. They then bring the shoulders forward to compress the chest muscles.
All these exercises need to be done under strict medical supervision, as they can worsen your symptoms.
In some severe cases, where no other treatment option helped, a surgery called costal cartilage excision might be required.
As the symptoms of slipping rib syndrome are general and nonspecific, they can be confused to be due to a different condition. Hence it is important to address the concern at the earliest and get treated soon.
There are no long term complications. The possible complications include:
Corticosteroid injection can result in lung collapse (pneumothorax).
Pain, in most cases of slipped rib syndrome, gets better with medications over time. In some rare cases, the pain becomes chronic, which requires injections or surgery.
For more information on slipping rib syndrome, talk to an orthopedician and traumatologist online through phone or video consultation.
A person with slipped rib syndrome might suffer from back pain, stomach pain, popping or clicking sensation in the ribs, and breathing problems.
With proper rest, applying heat and cold, painkillers (Ibuprofen, Naproxen), stretching, rotation exercises, and avoiding strenuous activities, most cases of slipped rib syndrome resolves on its own.
It usually takes around a week or 7 days for the symptoms of slipped rib syndrome to get better.
No, an X-ray will not help in diagnosing this condition. Slipped rib syndrome is usually diagnosed with the hooking maneuver. X-rays or MRI scan is done for differential diagnoses, which means to rule out other conditions that can result in similar symptoms.
This syndrome does not lead to any internal damage or severe complications. But in a few, it can cause longterm pain, which might make doing day to day activities such as turning while lying down or buttoning you bra painful.
Slipping rib syndrome has been reported to go away on its own without treatment in some. In case of severe and chronic pain, consider getting an intercostal nerve block.
If you experience chest pain, breathing difficulties, and shortness of breath, it is wise to consult a doctor immediately, as it can be signs of a heart attack or some other life-threatening conditions.
Avoid sleeping on the side where the ribs are sore or slipped. If possible, sleep in a supine position, that is lying flat with your face and torso facing up.
Query: Hello doctor, My mom had chest pain yesterday evening at 3 PM. It was mild pain on the left side. Today morning she also had mild pain three times. I had contacted a cardiologist yesterday. He asked me to perform an ECG test. After seeing the ECG report, he said there is little issue in ECG line. T... Read Full »
Query: Hello doctor, I slipped, fell and landed on my side four days ago and have been in a lot of pain since around my ribs on the left side. The pain has not lessened, sometimes feels worse. It hurts when I breathe so I have to take shallow breaths. I know that X-rays will not do much and I realize that... Read Full »
Query: Hello Doctor, I am a 23 year old male suffering from back pain. Mostly pain occurs during sleep at night and soon after I wake up in the morning. And the pain vanishes after sometime (approximately 10-15 minutes). What could be the reason for the pain? Read Full »
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