Slipping Rib Syndrome

Overview

Slipping rib syndrome is a condition in which the cartilage that attaches a lower rib to the rib above it becomes loose or slips out of its normal position. The lower ribs, sometimes called the false ribs, are connected by flexible cartilage rather than directly to the breastbone. When this cartilage moves abnormally, a rib can slip over or under a neighboring rib, irritating nearby nerves and tissue.

The result is pain in the lower chest or upper abdomen, often with a clicking, popping, or slipping sensation. Although the pain can be sharp and alarming, slipping rib syndrome is not dangerous to the heart or lungs. It is sometimes overlooked, and people may see several doctors before it is identified.

Because the pain can mimic problems with the heart, lungs, or digestive organs, slipping rib syndrome is often diagnosed only after other causes have been ruled out. Once it is recognized, many people feel reassured to learn that the condition, while uncomfortable, is not harmful and can usually be managed with simple measures.

Symptoms

Symptoms usually affect one side of the lower chest or upper abdomen and may include:

• Sharp pain in the lower chest or upper belly, sometimes followed by a dull ache
• A clicking, popping, or slipping sensation when moving, bending, or twisting
• Pain that worsens with certain movements, coughing, deep breathing, or lying on the affected side
• Tenderness when pressing on the lower ribs

The pain may be reproduced by a specific maneuver in which a doctor hooks their fingers under the rib margin and pulls gently. Because chest pain has many causes, a proper evaluation is important.

Causes

Slipping rib syndrome is caused by increased movement of a lower rib due to loose, weakened, or injured cartilage. This allows the rib to slip and irritate the nerves running along it. Contributing factors include:

• Injury or trauma to the chest, such as a fall or a direct blow
• Repetitive movements or strain, common in some sports
• Previous chest surgery
• Naturally more flexible or hypermobile cartilage in some people

In many cases, the exact trigger is not clear, and the condition develops gradually.

Risk Factors

• A history of chest injury or trauma
• Participation in sports that involve twisting or repetitive trunk movements
• Previous chest or abdominal surgery
• Conditions that cause more flexible joints and cartilage

Diagnosis

Diagnosis is based mainly on the history and a physical examination, since standard scans often appear normal:

• Physical examination: The hooking maneuver, in which a doctor gently pulls under the rib margin to reproduce the pain and clicking, can support the diagnosis.
• Ruling out other causes: Tests may be done to exclude heart, lung, and digestive problems that can also cause chest or upper abdominal pain.
• Imaging: Ultrasound can sometimes show the abnormal rib movement, though imaging is often used mainly to rule out other conditions.

Treatment

Many people improve with simple, conservative measures:

• Rest and activity changes: Avoiding movements that trigger the pain gives the area time to settle.
• Pain relief: Over-the-counter pain relievers and applying heat or cold can ease discomfort.
• Physical therapy: Exercises to strengthen and stabilize the trunk and improve posture can help.
• Injections: A local injection of anesthetic, sometimes with a steroid, can relieve pain in some cases.
• Surgery: For severe, persistent pain that does not respond to other treatments, a procedure to remove or stabilize the affected cartilage may be considered.

The outlook is generally good, and most people manage the condition successfully.

When to See a Doctor

See a doctor for persistent lower chest or upper abdominal pain, especially with a clicking or slipping sensation. Because chest pain can have serious causes, seek emergency care or call emergency services if you have:

• Crushing or pressure-like chest pain, or pain spreading to the arm, neck, or jaw
• Shortness of breath, sweating, nausea, or lightheadedness with chest pain
• Sudden severe pain after a significant injury

These can be signs of a heart or other serious problem that needs urgent evaluation.

Related Topics

Frequently Asked Questions

References

1. MedlinePlus, U.S. National Library of Medicine. Chest pain.
2. Merck Manual Consumer Version. Chest Wall Pain.
3. American Academy of Family Physicians (AAFP). Chest Wall Pain.
4. National Organization for Rare Disorders (NORD). Slipping Rib Syndrome.