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The Slipping Rib Syndrome: An Often-Overlooked Diagnosis

Because the condition is often overlooked, many unnecessary diagnostic exams are performed to work up the diagnosis (eg, plain radiography, CT, MRI). The gold standard for diagnosing the condition is a simple hooking maneuver, which was first described by Heinz and Zavala in 1977 and consists of having examiners slide their fingertips under the costal margin on the implicated side, then lifting anteriorly and superiorly. If the pain is reproduced, sometimes accompanied by a clicking sensation, the syndrome is diagnosed. Furthermore, to identify the location of the disease, local anesthetic can be injected at the suspected site; alleviation of the confirms the disease location.

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 Slipping Ribs?! Is that really what’s happening?

Are you feeling excruciating pain around the ribs? Have you been or know anyone diagnosed with slipped ribs? Doc Jen & Dr. Dom begin the conversation by talking into the ribcage and addressing the fear that commonly surrounds diagnostic verbiage, particularly with the use of “slipped” in this context. They explore the literature around the cause of “slipped” ribs, as well as the role and information imaging provides when receiving a referral from a physiotherapist, a medical diagnosis, or a differential diagnosis. By going back to the basics, they provide you with exercises and tips to help you establish support, safety, and stability in the body, ultimately easing and addressing the nervous system systemically.

 UHC Surgeon Provides Non-invasive Treatment for Slipping Rib Syndrome

Unfortunately, for many, slipped rib syndrome may go undiagnosed for years. The degeneration of surrounding cartilage around a rib does not show up on an x-ray, MRI, or CAT scan. The area of the pain is symptomatic for other common ailments, too. Even when properly diagnosed, many patients do not find pain relief from a rib removal surgery alone. They must commit to a lifetime of pain management through the use of narcotics. Through his practice, Dr. Hansen has found that patients who undergo his new procedure have experienced pain reduction of up to 85% after the first month, with almost 100% of the pain dissipating after six months. “This is an obscure diagnosis that a lot of people don’t know about,” Dr. Hansen said. “These patients are in debilitating pain and often suicidal. After this procedure, their pain is like night and day. Within a week after the repair, their lives are turned around.”

Articles of Interest

A Comprehensive Review of Slipping Rib Syndrome: Treatment and Management

Slipping rib syndrome stems from irritation of intercostal nerves. It is caused by slipping of the costal cartilage and the resulting displacement of a false rib and pinning underneath the adjacent superior rib and nerve irritation. It is rare and spans genders and ages; most evidence about epidemiology is conflicting and mostly anecdotal. Risk factors include trauma and high intensity athletic activity. Presentation is of a sudden onset of pain with jerking motion; the pain can be localized, radiating or diffuse visceral. It is often alleviated by positions that offload the impinged nerve. Diagnosis is clinical, and can be aided by Hooking maneuver and dynamic ultrasound. Definitive diagnosis is with pain relief on nerve block, visualization of altered anatomy during surgery and relief after surgical correction. Initial treatment includes rest, ice and NSAIDs, as well as screening for co-morbid conditions, as well as local symptomatic relief. Injection therapy with local anesthetics and steroids can provide a diagnosis as well as symptomatic relief. Surgical correction remains the definitive treatment.

A Review of Slipping Rib Syndrome: Diagnostic and Treatment Updates to a Rare and Challenging Problem

Slipping rib syndrome (SRS) is a disorder that occurs when one or more of the eighth through tenth ribs become abnormally mobile. SRS is a poorly understood condition leading to a significant delay in diagnosis and therapeutic management. History and a physical exam are usually sufficient for a diagnosis of SRS. The utility of dynamic ultrasounds has also been studied as a useful diagnostic tool. Multiple surgical techniques for SRS have been described within the literature. Cartilage rib excision (CRE) has been the most common technique utilized. However, the literature has shown a high rate of recurrence and associated risks with the procedure. More recently, minimally invasive rib fixation and costal cartilage excision with vertical rib plating have been shown as successful and safe alternative techniques.

Dr. Adam Hanson Slipping Rib Syndrome Evaluation

Slipping Rib Syndrome is a commonly overlooked diagnosis for abdominal pain and back pain. Often mimics gall bladder disease, appendicitis, and much more. In this video, Dr. Adam Hanson demonstrates his technique for evaluating for SRS, or Slipping Rib Syndrome.

Slipping Rib Surgery in EDS with Adam Hansen, MD

The conversation includes various topics related to slipping rib syndrome (SRS), including posture and exercise, taping strategies, avoiding high velocity manipulation, qualifications for surgery, preparing for surgery, surgical procedures, the Hansen 3.0 technique, outcomes and complications, hypermobility spectrum disorder and EDS, male-female differences, recurrence and additional slipped ribs, and physician awareness and education.

Slipping Rib Syndrome: A Comprehensive Guide

Slipping rib syndrome, also known as rib tip syndrome or clicking rib syndrome, may not be well-known but can cause significant discomfort and confusion for those affected. This condition involves the lower ribs—usually the 8th, 9th, and 10th, known as false ribs—slipping and moving in a way that can cause pain and other symptoms. Manual therapy can help reduce inflammation and alleviate pain by targeting the soft tissues and joints around the ribs.

The Slipping Rib Syndrome: An Overlooked Cause of Abdominal Pain

This series of cases illustrates the authors’ experiences of using intercostal nerve blocks and local infiltration of anesthetics to diagnose and treat this obscure syndrome.

What Is Slipping Rib Syndrome?

If you’re like most people, you rarely think about your rib cage…until it starts to hurt. It’s only then that you realize how much the ribs are involved in your daily movements. Though rare, slipping rib syndrome can have a tremendous impact on your daily life, even keeping you from doing the most basic tasks. If you’ve been suffering from the pain of slipping rib syndrome, you may have been told that you need physical therapy or even surgery to find relief. This is not always the case! By restoring the rib to its proper position, our chiropractors can relieve pressure on the intercostal nerves and allow the body to heal itself. In addition to chiropractic adjustments (which are minimally invasive), we also offer a wide range of medical massage techniques.

What You Should Know About Slipping Rib Syndrome

Slipping rib syndrome occurs when the cartilage (a tough but flexible material in your body) that usually keeps your ribs in place gets worn out or damaged. When this happens, one of your ribs can move more than it should, making it slip and slide a bit. The extra movement can impinge or irritate one or more of the nerves that help your chest and side (thoracic cage) experience sensations. Irritation of these nerves means you experience pain during normal activities and movements, including taking deep breaths.

Why Aren’t More of Us Talking About Slipping Rib Syndrome?

While SRS has been described in medical literature for more than a century, it’s still poorly understood and often misdiagnosed. Because SRS is relatively unknown among doctors, many of whom already have a general distrust of women’s complaints, patients... often lose months or years of their lives dealing with and trying to figure out the cause of their pain. Like many other chronic illnesses, SRS is hard to diagnose, adding another layer of stress. Hansen says many of his patients have seen 30 to 50 doctors, many of whom dismiss their pain or, at best, recommend ibuprofen and ice. “This is probably one of the most underdiagnosed conditions people have,” he says. “People just swirl around for years trying to figure out what’s causing their symptoms.” Like many other chronic illnesses, SRS is hard to diagnose, adding another layer of stress. Hansen says many of his patients have seen 30 to 50 doctors, many of whom dismiss their pain or, at best, recommend ibuprofen and ice. “This is probably one of the most underdiagnosed conditions people have,” he says. “People just swirl around for years trying to figure out what’s causing their symptoms.”

Resources

Physiopedia

Pain associated with slipping rib syndrome has distinct characteristics which can be used in identifying the syndrome: Intermittent sharp stabbing pain followed by a constant monotonous pain that may last from several hours to many weeks.

Rib Injury Clinic

Diagnosis of Slipped Rib Syndrome can often be difficult due to the nature of the pain and the many other chest or abdominal conditions that can cause pain in this part of the body. Seeing a doctor who is familiar with Slipped Rib Syndrome is important in assessing and investigating the condition. Clinical examination may relieve tenderness over the area and occasionally the hypermobile rib tip can be palpated and if moved can generate the pain (the hook Manoeuvre). Patients may have had multiple investigations already and often Chest CT or even MRI tends not to be helpful. Dynamic Ultrasound with a radiologist experienced with Slipped Rib Syndrome is essential and often allows the radiologist to demonstrate excessive movement of the rib tip affected.

Slipping Rib Syndrome .org

This website was created to raise awareness of Slipping Rib Syndrome, and to provide information, advice and support to sufferers of this painful, debilitating and often rarely diagnosed condition. ​