Jonathan Aarons M.D.

Tired of Chronic Pain?

Slipping Rib Syndrome

“Hooking Maneuver” for Diagnosis of Slipping Rib Syndrome

Slipping Rib Syndrome is an uncommon cause of chest and upper abdominal pain.  The pain is caused by hypermobility of the tips of the ribs 8, 9 and 10.  The upper ribs, 1 through 7 are fixed onto the sternum.  Ribs 8,9 and 10 are joined only by fibrous tissue.  Slipping Rib Syndrome ususally occurs after traumatic injury such as in a car accident.  The pain is located under the ribs and in the upper abdomen.  Pain is reproduced by pressure on the ribs.  A “hooking maneuver”, where the clinician hooks his fingers under the affected ribs and pulls outward to reproduce the pain, is useful in confirming the diagnosis.  The pain of slipping rib syndrome can be mistaken for gall bladder disease and cardiac disease necessitating visits to the emergency room and multiple diagnostic studies such as EKG and MRI and CT scan of the abdomen.  It can also be confused with Tietze’s syndrome or constochondritis as well as pulmonary diseases.  The initial treatment is conservative and involves rest, heat, ice, non-steroidal anti-inflammatory medications and physical therapy.  Intercostal nerve blocks and injects into the costal cartilages can be very useful in treating this problem as well.

4 comments on “Slipping Rib Syndrome

  1. Jonathan Aarons MD says:

    Paula
    Sorry to hear that you are having problems. If the ribs keep popping out then it sounds like a mechanical problem so the solution is mechanical. I would visit a reputable physical therapist and ask for solutions such as a brace to provide support for those ribs. There is no injection that would help this type of problem. In severe cases, you can surgically remove the ribs but that may create more problems then they solve. Good Luck

    DR A

  2. paula says:

    Dr. Aarons, I have thoracic ribs 3 on the right side (upper back) that seem to be permanently popped out. I see a muscoskeltal do dr. That pushes them back in and within a day they are popped back out. The condition is extremely painful. Have you encountered this? What can be done to keep the ribs in place?

  3. Jonathan Aarons MD says:

    I can try to inject the cartilage. No guarantee that it will help. Will need to see you and evaluate your condition first. Injection of the cartilage is not without risk and I am happy to discuss it with you when you come to see me. Please call the office at 954-580-8838 to schedule an appointment

  4. jessica klewicki says:

    Dr Aaron’s do you treat people with this syndrome?

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