Teach Me

Slipping Rib Syndrome: Understanding This Rare Condition

Slipping rib syndrome is a rare and unusual condition—in fact, it’s often mistaken for other health problems. People with slipping rib syndrome have pain on one side of the chest or upper abdominal wall when they move, cough or sneeze. The pain feels like it’s coming from a particular rib, and sometimes people notice a popping or clicking sound. The rib may be displaced or dislocated where the bone meets the cartilage at the front of the chest or rib cage.

Edward Charles, MD, a surgeon with Banner Health, said it’s not clear what causes slipping rib syndrome, but it can occur after trauma to the chest wall such as an injury from contact sports or an accident. “Short of avoiding injuries to the chest wall, there is no specific way to prevent this condition,” Dr. Charles said

When slipping rib syndrome occurs on the lower ribs on the right side, it can be mistaken for gallbladder disease. Doctors might also suspect hernias, soft tissue masses or gastrointestinal conditions when it occurs elsewhere.

What causes slipping rib syndrome?

It’s usually trauma that causes slipping rib syndrome. It’s possible, but unclear if repetitive movements, overuse injuries or muscle imbalances could cause it. Underlying conditions such as weak abdominal muscles, scoliosis or hypermobility might make it more likely that you could develop slipping rib syndrome.

Symptoms of slipping rib syndrome

People with slipping rib syndrome notice rib pain with specific movements, along with a clicking or popping sound. They may also have rib movement, tenderness and pain that radiates to the back or shoulder.

How is slipping rib syndrome diagnosed?

“There is no clear diagnostic test to prove and confirm the diagnosis of slipped ribs,” Dr. Charles said. Diagnosing slipping rib syndrome can be challenging, because your doctor may need to rule out several other conditions that can have similar symptoms:

  • Intercostal neuralgia, or inflammation or irritation of the intercostal nerves that run between the ribs. 
  • Costochondritis, which is inflammation of the cartilage that connects the ribs to the sternum. 
  • Tietze syndrome, a condition with painful swelling of the cartilage that connects the ribs to the sternum.
  • Thoracic outlet syndrome (TOS), where the nerves and blood vessels between the neck and shoulder get compressed. The location of pain in TOS is usually in the arm, shoulder or neck rather than in the lower chest. 
  • Muscle strain or sprain, which can stem from injury or overuse of the muscles in the chest or abdomen. 

With these conditions, you won’t typically see the rib movement, displacement, clicking or popping you’ll likely have with slipping rib syndrome.

To make a diagnosis, your doctor may take these steps:

  • Medical history evaluation. Your doctor will ask about your symptoms and medical history. They may want to know about your pain’s location, intensity and duration and what makes it worse or better. They may want to know about your daily activities, previous injuries or underlying conditions.
  • Physical examination. Your doctor may gently press on your ribs to identify tender points, areas of discomfort, deformity or mobility problems. They will watch and listen for any clicking or popping sensations. 
  • Diagnostic anesthetic block. If injecting a local anesthetic near the affected rib alleviates the pain, that could suggest that slipping rib syndrome is the cause. 
  • Imaging tests. Tests like X-rays, magnetic resonance imaging (MRI) or computed tomography (CT) scans can’t diagnose slipping rib syndrome, but they could be used to identify other potential issues. 

How is slipping rib syndrome treated?

“Treatment is controversial,” Dr. Charles said. In fact, some experts aren’t even certain that slipping rib syndrome exists.

Your doctor may recommend:

  • Resting and avoiding activities that worsen symptoms so your ribs can heal. You may need to avoid twisting and bending. 
  • Over-the-counter pain medications such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs). 
  • Applying heat or cold packs to the affected area. Alternating between both may be helpful. 
  • Physical therapy. A physical therapist can design an exercise program to help you improve your posture, strengthen your core and increase your stability. They may also use techniques that provide pain relief. 

If those treatments don’t alleviate your symptoms, your doctor might suggest:

  • Prescription medications such as stronger pain medications or muscle relaxants. If you try these medications, you’ll need to be closely monitored and managed.
  • Local anesthetic or corticosteroid injections around the affected rib or ribs can help reduce pain and inflammation.
  • Surgical intervention. It’s rare to treat slipping rib syndrome with surgery. But if other treatments don’t work, your rib is severely displaced or your pain is persistent, it could be an option. Surgeons could remove part of your rib or stabilize it with plates and screws. 

“The main thing to keep in mind about this syndrome is that unless there was a traumatic injury that led to rib or chest wall instability or deformity that can be observed on exam, slipping rib syndrome remains a controversial diagnosis with highly variable treatment results,” Dr. Charles said.

How can you prevent slipping rib syndrome?

Since slipping rib syndrome is usually caused by trauma, it can be hard to prevent it. But you can take some steps to keep your ribs, chest and core strong and healthy:

  • Maintain good posture without slouching or hunching to reduce strain on the ribs.
  • Keep your core strong so your ribs have more support, and your body is more stable.
  • Stretch to maintain flexibility, improve mobility and reduce muscle tension.
  • Exercise, maintain a healthy weight and avoid nicotine to promote your overall musculoskeletal health. (Be sure to talk to a health care professional before you start a new fitness routine.)

When should you seek help for slipping rib syndrome?

Call 911 or have someone take you to the emergency room if you have:

  • Severe or intolerable pain that is not responding to over-the-counter pain medications or home remedies. This could mean that you may have a more serious underlying issue or complications. 
  • Difficulty breathing. This can be a sign of rib displacement or compression beneath the ribs. 

Contact your doctor if you:

  • Suspect you have slipping rib syndrome but haven’t been diagnosed.
  • Have persistent symptoms after trying rest, activity modification and pain management techniques.
  • Have new or unexplained symptoms, including pain that spreads to the back, shoulders or arms. 

The bottom line

Living with slipping rib syndrome can be challenging. Following your doctor’s advice can help you manage pain and discomfort, so keep the lines of communication open. You may also want to seek support from loved ones. If you would like to talk to a health care provider to see if slipping rib syndrome could be causing your pain, reach out to Banner Health.

Other useful articles

Emergency Orthopedics Physical Therapy