SLIPPING RIB SYNDROME: SYMPTOMS, DIAGNOSIS, TREATMENT AND MORE
Medically Reviewed by Dr. Sony Sherpa (MBBS) - July 30, 2024
Slipping rib syndrome (SRS) is a condition that affects the lower chest and causes significant discomfort and chronic pain. This syndrome occurs when the cartilage attaching the ribs to the sternum (breastbone) slips out of place, causing discomfort and pain.
The rib cage comprises 12 pairs of ribs, with the first seven pairs attached to the sternum by costal cartilage. Three of the remaining five pairs are known as false ribs and are weakly attached to the sternum with fibrous bands. The remaining two are known as floating ribs (unattached). The intercostal muscles line the ribs and help expand the rib cage during breathing.
In SRS, the cartilage that connects the ribs to the sternum becomes inflamed or damaged, causing the false ribs to slip out of place. A slipped rib can happen due to trauma, repetitive strain, congenital deformity, or a neuromuscular disorder. The slipping of these ribs can cause irritation to the intercostal muscles and influence the nerves, leading to chronic pain.
The condition has many other names, including floating rib syndrome, slipping-rib-cartilage syndrome, twelfth rib syndrome, cyriax syndrome, and interchondral subluxation[1]. The prevalence of slipping rib syndrome is relatively unknown, although it is more common in middle-aged individuals and women than in men. It can affect people of all ages.
This article takes a look at the symptoms, risk factors, diagnosis, and treatment options for slipping rib syndrome.
Symptoms of Slipping Rib Syndrome
The most common symptom of SRS is a chronic stabbing pain in the lower chest area that often leaves the person feeling winded when they use the affected muscles. The pain spans from mild to extreme and can be felt on both sides, yet one-sided pain is more common. The chest pain may also radiate to the back, abdomen, or shoulder[2] and is often confused for heartburn and other digestive symptoms.
Other symptoms may include:
- Pain that intensifies with deep breathing or movement
- A popping, clicking sensation that occurs in the chest
- Tenderness or swelling in the affected area
- Difficulty taking deep breaths, coughing, laughing, eating, or bending over without pain
- Numbness or tingling sensation in the chest area or abdomen
- Difficulty sleeping due to pain
If you experience any of these symptoms, it is essential to note when the pain began and if any changes to the symptoms occur and to speak to an experienced doctor for a proper diagnosis.
If left untreated, SRS complications include:
- Chronic pain and discomfort that can last years or indefinitely without treatment
- Nerve impingement, which can cause numbness, tingling, or weakness in the chest or abdomen
Risk Factors for Slipping Rib Syndrome
While the exact cause of SRS is unknown, several risk factors can raise your chances of developing this syndrome. These include:
- Repetitive strain or overuse of the chest muscles caused by overexertion or a chronic cough
- Athleticism due to the high risk of chest injury
- Chest injury or trauma, such as a fall or car accident
- Pregnancy, due to the increased pressure on the chest
- Poor posture or scoliosis
- Connective tissue disorders, such as Ehlers-Danlos syndrome
- Neuromuscular disorders, such as Marfan syndrome or muscular dystrophy
- Congenital deformities of the musculoskeletal system
Diagnosis of Slipping Rib Syndrome
Diagnosing SRS can be challenging, as the symptoms are similar to other conditions, such as costochondritis or pneumothorax. Typical scans used for diagnosing slipped rib syndrome often fail to detect the condition, and in many cases, it takes a specialist doctor to make the correct diagnosis.[3]
A doctor starts with a detailed medical history and performs a physical exam. They would ask when the pain began, where it is most intense, if the quality of the pain changes, and what triggers it most.
The most common confirmatory diagnostic test for SRS is the hooking maneuver. This test involves the doctor placing their fingers under the rib tips and pulling them forward while the patient inhales deeply. If this maneuver reproduces the patient's pain with clicking sounds, it strongly indicates SRS.
The doctor may also perform imaging tests, such as an X-ray or MRI, to rule out other conditions. The signs of SRS are subtle on most imaging tests and manage to escape the notice of most inexperienced doctors.
Some studies suggest that the best imaging tool for detecting SRS is dynamic ultrasound[4] coupled with the hooking maneuver.[5]
SRS may be misdiagnosed for conditions with similar symptoms. Other conditions that mimic SRS include[6]:
- Digestive issues, including cholecystitis (gallbladder inflammation), GERD (gastroesophageal reflux disease), throat inflammation, gastric ulcers, appendicitis, and liver issues
- Chest wall injuries
- Pleurisy or pneumothorax
- Costochondritis or Tietze syndrome
- Bone cancer
- Heart disease
Treatment Options for Slipping Rib Syndrome
Treatment for SRS usually begins with a conservative approach.
Patients are not aware they have a slipped rib at first, tending toward pain management strategies and digestive aids. Upon diagnosis, a doctor will often recommend conservative treatment unless the symptoms have persisted for a substantial time without treatment.
Conservative treatment options include[7]:
- Rest and avoid activities that worsens the pain
- Apply ice or heat to the affected area
- Over-the-counter pain medication
- Physical therapy to strengthen the intercostal muscles and improve posture
- Steroid injections to reduce inflammation and pain
- Chiropractic adjustments to realign the ribs and relieve pressure on the nerves
- Acupuncture
Surgery is necessary to repair the damaged cartilage and stabilize the ribs after conservative treatment fails to improve the outcome.
Surgical procedures used to treat SRS include[8]:
- Partial Rib Resection: In this procedure, a portion of the affected rib is surgically removed to alleviate slipping rib syndrome (SRS) symptoms by reducing the pressure and irritation on the surrounding tissues.
- Minimally Invasive Slipped Rib Repair: This technique involves a minimally invasive approach to address slipped rib syndrome without removing the costal cartilage. It involves making small incisions and using a camera and specialized tools to repair the cartilage. This procedure aims to stabilize the ribs and alleviate pain with less tissue disruption.
- Vertical Rib Plating with Bioabsorbable Plates: This procedure involves using bioabsorbable plates positioned vertically along the ribs to provide support and stability, aiding in the repair of slipped rib syndrome. The plates eventually dissolve within the body, reducing the risk of long-term complications.
The prognosis of surgery is excellent. After several weeks of recovery, the patient is out of pain and can resume ordinary activities, including eating and bending over.
SRS may recur in patients, even after surgery. Chest strengthening exercises are essential to conserve the area and lower the risk of recurrence.
Living with Slipping Rib Syndrome
Living with SRS can be challenging, and the pain and discomfort can substantially detract from daily life. However, there are provisions that can help deal with these effects and improve quality of life. These include:
- Making use of conservative measures such as resting, pain relief medications, exercises, and warm compresses
- Practicing good posture and avoiding slouching
- Using chest braces that remind you to maintain good posture without pressuring the area
- Seeking support from friends and family
- Joining a support group for people with SRS
What Are the Latest Advancements in Research on SRS?
While there is still much to learn about SRS, there have been some recent advancements in research.
Some of the minimally invasive surgeries listed above are relatively new developments in treating SRS, with better outcomes for rib resection[9]. They cut the patient's hospital stay short and lower the risk of complications. A small study highlights how rib plating drastically lowered the risk of SRS recurrence from 17.1% to 3.4% during a ten-year follow-up period[10].
Another study shows that the risk of recurrence may increase in those with weaker chest wall muscles, specifically those with a thinner ipsilateral rectus abdominis muscle[11]. This finding highlights the effectiveness of physical therapy for treating and managing SRS.
In the future, a better understanding of musculoskeletal disorders and congenital deformities may help to identify those at risk and prevent SRS.
Stem cell therapy may also become a viable treatment option for pain relief and rib regeneration, although studies are currently lacking.
Conclusion
Slipping rib syndrome impacts the lower chest and causes chronic pain. It happens when the cartilage that connects the ribs to the sternum slips out of place, causing discomfort and pain. While a precise cause is not certain, there are known risk factors that may increase your chances of developing this condition. Treatment options include rest, physical therapy, and surgery in severe cases. With proper management, living a fulfilling life with SRS is possible. If you experience any symptoms of SRS, seek out medical attention immediately for a proper diagnosis and treatment plan.
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