What is Slipping Rib Syndrome ?

Slipped rib syndrome (“slipping rib syndrome”) is the constellation of symptoms resulting from the impingement of intercostal nerves between slipping rib tips.

Due to various factors, such as trauma or degeneration, disruption of the interchondral attachments between ribs can result in weakness and rib separation at the costal margin.

This results in hypermobility and subluxation of the rib; the tip of the hypermobile rib can impinge on the intercostal nerve of the rib above, causing a complex pain response with activity and movement, leading to limitations in quality of life.

Intercostal nerves are highly sensitive and prone to producing chronic pain when injured. It may generate severe pain in a dermatomal distribution in the affected intercostal space, originating anteriorly and radiating back to the spine. Such intercostal neuralgia is the predominant symptom observed in SRS.

To diagnose slipping rib syndrome, an examination must be conducted by medical providers who possess knowledge and training in this rare debilitating syndrome. 

In many cases, radiologic imaging of the chest and abdomen, such as chest X-rays, MRIs, and regular CT scans, do not reveal any abnormalities. While costal cartilage may not be visible in regular CT scans, 3D CT or High-Resolution scans can uncover protruding ribs and costal cartilage. High-resolution ultrasound (Dynamic ultrasound) can confirm the ribs' movement and compression of muscles, tendons, and intercostal nerves. 

Although Slipping Rib Syndrome was identified by a British orthopedic surgeon in 1919, it remains a relatively obscure condition in the medical field. 

The latest publication (2023), “A Review of Slipping Rib Syndrome: Diagnostic and Treatment Updates to a Rare and Challenging Problem.” shows SRS is a poorly understood diagnosis resulting in significantly delayed and unnecessary diagnostic tests. Early and accurate diagnosis coupled with timely referral to a surgical provider with expertise in SRS is the most important aspect of treatment. 

The study also shows that delay in diagnosis and treatment has a profound effect on patients’ mental health. One-third of patients in an adult SRS cohort had suicidal ideations due to pain; three patients had attempted suicide. Other studies have shown an increased likelihood of SRS patients linked with a psychiatric diagnosis, including depression. This may be linked with ongoing chronic pain, as well as the overall strain between the patient and provider, given the delay in diagnosis of slipped rib syndrome in these patients.

Studies estimate that Slipping Rib Syndrome accounts for approximately 5% of all musculoskeletal pain in primary care. Slipping rib syndrome may be more common than previously documented.

We aim to increase awareness of this debilitating condition, "Slipping Rib Syndrome," to expand access to diagnosis and treatment.