Slipping Rib Syndrome - Symptoms, Causes, Diagnosis, and Treatments

What Is the Anatomy of the Ribs?

In general, there are three types of ribs, namely,

• True Ribs - These are the first seven ribs attached to the sternum (breastbone) with the help of costosternal joints and ligaments.

• False Ribs - These are ribs from 8 to 10, attached to one another with the help of weak fibrous or cartilaginous bands. Slipping rib syndrome usually involves false ribs.

• Floating Ribs - The floating ribs are the eleventh and twelfth ribs because they are neither attached to the sternum nor attached to one another.

What Is Slipping Rib Syndrome?

Slipping rib syndrome is a rare condition where the ribs fall 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 are attached to each other by loose tissues and ligaments. Although this allows for more flexibility and movement, it makes these ribs more prone to slipping in case of an injury or blow.

How Is Slipping Rib Syndrome Otherwise Called?

• Slipped rib syndrome.

• Clicking rib syndrome.

• Displaced ribs.

• Painful rib syndrome.

• Rib-tip syndrome.

• Intercostal subluxation.

• Twelfth rib syndrome.

• Slipping-rib-cartilage syndrome.

• Chest pain-slipping rib.

• Rib subluxation.

How Prevalent Is Slipping Rib Syndrome?

Slipping rib syndrome is a condition that usually affects 20 to 40 percent of individuals; however, it does not affect younger children. This is due to their chest flexibility. Slipping rib syndrome is relatively common in middle-aged women but can occur in individuals of any age.

What Are the Clinical Features of Slipping Rib Syndrome?

• Slipping rib syndrome can result in symptoms that vary from one person to another. The common symptoms include:

  • Sharp and intermittent stabbing pain in the upper abdomen or back followed by a dull and achy feeling.

  • Sensations of the lower ribs slipping or popping.

  • Breathing difficulties.

These symptoms worsen on bending, coughing, lifting heavy objects, sneezing, stretching, and deep breathing. Only one side gets affected in most cases, but it can affect both sides. Consult a doctor immediately if one experiences breathing problems or chest pain, as these are also signs of a heart attack.

What Is the Etiology of Slipping Rib Syndrome?

There are various causes of slipping rib syndrome, which include:

• Weakness in chest muscles or ligaments - This is because of hypermobility of the eighth, ninth, and tenth ribs.

• Trauma or injury to the ribs.

• Sinusitis.

• Asthma.

• Bronchitis.

• Degeneration of muscle tissue that is attached to the ligaments.

• Severe and persistent cough.

How to Diagnose Slipping Rib Syndrome?

After a thorough history, the doctor 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 move upwards and backward. If this action leads to pain, then a diagnosis is completed. As many other conditions can result in similar symptoms, the doctor will try to rule out these conditions with the help of some tests.

Does Slipping Rib Syndrome Have a Differential Diagnosis?

Some other conditions that result in similar symptoms are:

• Sleep disturbances with liver cirrhosis.

• Cholecystitis (inflammation of the gallbladder).

• Costochondritis (inflammation of the chondral cartilage).

• Esophagitis (inflammation of the esophagus).

• Stress fractures.

• Muscular tears.

• Stomach ulcers.

• Some heart problems.

• Bone cancer.

• Bronchitis.

• Asthma.

• Appendicitis.

What Are the Different Treatment Modalities for Slipping Rib Syndrome?

Various treatment options are available and given depending on the severity of pain and discomfort.

For mild to moderate symptoms, the treatment options include:

• Alternative Hot and Cold Compression - Apply hot and cold compressions alternatively three to four times a day, which 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 at the site of pain, which helps reduce swelling.

• Botulinum Toxin (Botox) - Botox is injected into the muscles surrounding the rib cage for relieving pain.

• Ultrasound Therapy - The nerve endings are blocked to reduce swelling and promote rib mobilization.

• Prolotherapy - Here, nerve endings are stimulated, which promotes the body's natural healing process.

What Are Alternative Treatments Option Available for Slipping Rib Syndrome?

• Breathing Exercise - Take a deep breath and release the breath slowly after holding the breath for 10 to 15 seconds. This exercise will help in increasing rib mobilization.

• Pressure Exercises - A doctor will carefully apply pressure on the chest wall and ask to take deep breaths. The pressure application area is moved from one place to another.

• Chest Muscle Expansion - Thoracic extension and flexion exercises can be done in which the patient sits or stands straight and pushes their shoulder back. This expands the chest muscles. They then bring the shoulders forward to compress the chest muscles.

• Seated Rotation Exercises - This is done by sitting and turning the chest and shoulder on one side as much as possible. Similarly, it should be done for the other side.

• All these exercises need to be done under strict medical supervision, as they can worsen the symptoms. In some severe cases, where no other treatment option helped, a costal cartilage excision surgery is done.

As the symptoms of slipping rib syndrome are general and nonspecific, they can be confused with a different condition. Hence it is essential to address the concern earliest and get treated soon.

What Exercises Should be Performed to Avoid Slipping Rib Syndrome?

Slipping rib syndrome is characterized by joint instability. Therefore, the affected person should avoid push-ups and exercises with throwing or pitching motions as this exercise exerts pressure on the chest. Also, contact sports like football, basketball should be avoided.

What Are the Major Complications of Slipping Rib Syndrome?

There are no long-term complications. The possible complications include:

• Breathing difficulties.

• Corticosteroid injection results in lung collapse (pneumothorax).

Does Slipping Rib Syndrome Have a Good Prognosis?

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. Talk to an orthopedic surgeon and traumatologist online through phone or video consultation for more information on slipping rib syndrome.

Conclusion

Slipping rib syndrome does not always require long-term treatment and can reside on its own. The affected person requires an intercostal nerve block or surgical treatment in severe cases. When a person is diagnosed with slipping rib syndrome, they should not be involved in sporting activities or exercises that apply pressure on the chest to reduce further complications.