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Slipped rib syndrome goes by many names. It may be called rib subluxation, rib tip syndrome, sliding rib, gliding rib, false rib syndrome, clicking rib, and other names. This condition is rare, but it may account for about five percent of chest pain caused by muscle and bone (musculoskeletal) disorders. Slipped rib is a painful condition caused by abnormal movement of a rib out of place.
What is a Slipped Rib – Is My Rib Really Out of Place?
To understand how a rib slips and goes out of place, you have to know the anatomy of your ribs. Your rib cage protects your heart and lungs. Ribs attach to your spine and wrap around to attach to your chest bone (sternum). Your upper ribs attach directly to your sternum, but your eighth, ninth, and tenth ribs only attach to the rib above them by tissues called cartilage and ligament. These are called the false ribs.
Slipped rib occurs when a false rib develops a weak connection to the rib above it. The front tip of the rib curls and slips under the rib above it. A slipped rib can be very painful because it stretches the nerve that runs between the ribs called the intercostal nerve. Slipped rib pain may also cause pain due to stretching or tearing of cartilage or ligament tissue.
Slipped rib syndrome can happen to anybody, but is most common in middle-aged females. It may occur after a blow to the chest from a fall or contact sports injury. Motions like heavy lifting, pulling, throwing, or twisting may cause the rib to slip. It can also occur without any obvious trauma. It may be that some people are born with weaker connections between their false ribs, making them more moveable, called hypermobility.
Symptoms of Slipped Rib Syndrome
The most common way this syndrome starts is with sudden, one-sided, and intense pain in the lower chest, upper belly, or flank. The pain may start during an upper body movement and there may be a clicking or popping sound. There may or may not be a history of trauma to the chest. There may be a history of work, exercise, or sporting activity that has overused the chest muscles. The intense pain is usually followed by and aching pain and soreness. Intense pain may be triggered by turning in bed, lifting, pulling, or just getting out of a chair. Pressing over the rib also causes pain.
Diagnosis of Slipped Rib
The pain of slip rib syndrome can mimic many other chest or abdominal conditions including gall bladder disease, heartburn, pancreatitis, stomach ulcer, bronchitis, appendicitis, angina, kidney disease, or Tietze syndrome. Tietze syndrome is inflammation of the cartilage that attaches the upper rib to the sternum. Because many conditions mimic slipped rib syndrome, the diagnosis is often missed or delayed.
The diagnosis can be made with a physical exam, a diagnostic injection, or with an imaging study:
- During a physical exam the health care provider may press on the front of the ribs to see if the area is tender. A test called the hooking maneuver suggests a slipping rib. During this maneuver a health care provides slips fingers under the bottom of the rib cage and lifts it forward. This maneuver will cause pain and clicking from a slipped rib.
- Injecting a numbing medication into the area of the rib may be done to relieve pain and help with the diagnosis. If pain stops after the injection, it suggests slipped rib.
- Imaging studies like X-ray or CT scan often miss a slipped rib. The best imaging study is sound wave imaging (ultrasound) during movement, called dynamic ultrasound. This study detects slipped ribs in about 90 percent of cases.
Treatment of Slipped Rib
Slipped rib will often resolve on its own in a few weeks. Treatment may start with rest, avoiding any painful movements, heat or cold packs, and over-the counter pain relievers that reduce inflammation like Advil, Motrin, or Aleve.
If pain is severe, injecting a numbing medication with a steroid may help. Self-adjustment of a rib out of place is not recommended, but working with physical therapist and doing some physical therapy exercises at home may help. If all else fails, surgery may be done to remove the slipped rib.