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.

31 comments on “Slipping Rib Syndrome

  1. Emily says:

    I have had pain under my left rib for years on and off but it would usually go away, within the last few months my rib has hurt so badly and Ive been in pain everyday and cant workout. Im 25 and pretty healthy Id say. I got a CT scan that didnt show anything and my physical therapist diagnosed me with slipping rib syndrome but he has never treated it and doesnt know the next steps. If you could advise me on what to do next or know anyone I could see near Denver Colorado I would appreciate it. I would travel out of state, get surgery where ever- if I knew that would get rid of this pain.

  2. Jonathan Aarons MD says:

    Usually not in the back although anything is possible. Don’t believe much in chiropractic. It’s pretty much voodoo medicine to me. Could be scapulocostal syndrome. But hard to tell without seeing you in person. Try to find a board certified pain doctor. Google interventional pain management and your zip code. Good luck.

    Dr A

  3. Anne Shihadeh says:

    Does this condition occur on the back side? My rib near my scapula has been out about 80% of the time for over 8 years. Chiropractor puts it in and it goes out before I get home. Most M.D.s look at me like I have 3 heads when I ask them about it. Pain doc didn’t even listen to me. I used to be able to put it back in with a new tennis ball up against the wall but not anymore. I have a torn rotator cuff but I don’t think it is related to the pain for n my scapula. Maybe there’s a different name for it when it’s not on the front side? I’m at the end of my rope! Desperately need relief that lasts!

  4. Jonathan Aarons MD says:

    You can see if USF has a pain clinic. Otherwise I am happy to see you in Fort Lauderdale. This is a difficult problem to treat and I don’t make any promises.

  5. Yvonne says:

    Does anyone know of a doctor that treats slipping rib syndrome this in the Tampa Bay Area of Florida? My 18 year old daughter needs a doctor for this. Thanks!

  6. Jonathan Aarons MD says:

    Very hard to tell from far away. It could be but it could be other things too. Needs a full evaluation.

    Dr A

  7. Kelly says:

    I went to the emergency room due to severe pain and pressure under my right rib cage. The pain was unbearable, I felt like my right rib cage was being pushed outward and then it finally shifted outward and I had pain right between the center of my rib cage. The pain subsided a bit, but, after, I have been unable to sit for long periods of time due to the pressure and discomfort under my right rib cage, I find it difficult to breath at times, I cannot sleep on my right side – only on my left, I have become less and less active because when I try to be active, the pain and pressure come back and this past year and have gained some weight (I had my gall bladder removed over 20 hrs ago, so, I know it is not that). Does this sound like it could be slipping rib syndrome?

  8. Jonathan Aarons MD says:

    Yes. I can try intercostal blocks. Call my office for appointment. 954-580-8838

    Dr A

  9. Paul says:

    Dr. Do you treat slip rib pain?

  10. Jonathan Aarons MD says:

    I am sure there are plenty of high quality facilities in Dallas but I do not know any by name. You may need to see a physiatrist and have some physical therapy as well.

    Dr A

  11. Robin says:

    Are there any doctors in Dallas tx. area that treat or have knowledge of this slipping rib syndrome. My bottom 2 ribs on both sides in front are completely twisting and potruding until I manage to push them back into place. I go for sometimes 3 weeks before the pain subsides and I just can’t take this pain anymore.

  12. Jonathan Aarons MD says:

    Sorry. 954-580-8838

  13. Jonathan Aarons MD says:

    It’s hard to tell without examining you. It could be many things. You could start with you primary physician. If you would like to come in for an evaluation I would be happy to see you. You can call the clinic at 954-580-8839

  14. Ed says:

    Hello Dr, My mane is Ed.Last year while sitting watching tv I was in a kind of twisted position. It was then when I first started feeling a strange sensation in my lower right rib. I have undergone all kinds of tests, MRI, Ultrasounds, ct cans without any finding. My pain desapears while I am lying down and once I wake up and start bending over it stats hurting like an inflammation. When I am in a sitting position like when driving it turns unbearable. I have been like that for a year. Could it be a slipping rip syndrome? could you help me with this problem? I am really worried and desperate. Thank you!

  15. Danielle Botdorf says:

    My pain management specialist is looking into a permanent one for me, but isn’t sure if he can put it in because of allergies

  16. Jonathan Aarons MD says:

    Think you are doing everything that I would normally do. If the sensation you are having is pain, you could consider a spinal chord stimulator. I do not do those myself but there are plenty of pain doctors that do. Just a thought.

    Dr A

  17. Danielle Botdorf says:

    I was diagnosed a year ago and am bilateral, tried physical therapy, restorative physical therapy, and neither of those have worked. And my pain medications no longer help me either. I have moved onto intercostal nerve blocks, but it only helps on my right side. I have seen many doctors, but no one seems to be able to give long-lasting relief or even provided me with permanent relief options. Do you have any other suggestions?

  18. Jonathan Aarons MD says:

    Thanks. I will check it out
    Dr A

  19. Nelson L. Turcios, MD says:

    Would suggest for updated info:
    Slipping Rib Syndrome: An Elusive Diagnosis
    Nelson L. Turcios, MD
    Paediatric Respiratory Reviews March 2017
    Elsevier Publisher

  20. Jonathan Aarons MD says:

    I do not know anyone in New York. This is a complicated problem. Try to find an interventional pain Management physician through the anesthesiology department of your closest university.

    Dr A

  21. Brian says:

    I have been struggling with symptoms like slipping rib syndrome for 2 years and have been seeing a physical therapist and sports medicine doctor to no avail. Do you have any recommendations of doctors in NYC that might be able to treat this? Thanks!

  22. Jonathan Aarons MD says:

    Not very many people treat this condition. The main treatment is physical therapy with binders to hold the rib, chiropractic manipulation, nerve blocks and medications. In rare circumstances the ri can be surgically removed. I do not know of anyone that specializes in this. Hope this short reply is helpful

  23. C Kronsten says:

    Hi Dr Aaron, I am from the U.K. and believe I have slipping rib syndrome. I have tried ice, rest and analgesia and physiotherapy but I am still in agony.
    I also have EDS and fibromyalgia and I am having difficulty finding anyone with knowledge of this condition in the U.K.
    I would be very grateful if you could point me in the right direction if you know of anybody?
    Thank you very much in advance.

  24. Jonathan Aarons MD says:

    It certainly sounds like slipping rib. I would try a binder to see if you can keep the rib in place. Physical therapy may be helpful. I don’t know anyone in CT where you live. Hope it helps.

    Dr A

  25. Alissa Harrison says:

    I have been trying to find a diagnosis for 4 years and have finally found a thoracic surgeon who thinks I have slipping rib. I can push on a rib in the back left side and feel a pop then pain relief while I hold it. Have you ever seen this? Also can slipping rib cause epigastric symptoms that include digestion issues? I am in Ct if there are any doctors you know of in New England that have a special interest in slipping rib that you could refer me to I would be very grateful!

  26. Jonathan Aarons MD says:

    Intercostal block may work. You could find a pain doctor to do it. No guarantees and there are risks involved

  27. Kathryn Germano says:

    I think I. Have it none can figure it out and I am in horrible pain what do i do

  28. Jonathan Aarons MD says:

    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

  29. 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?

  30. 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

  31. jessica klewicki says:

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

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