Ribs / Chest Wall
Slipping Rib Syndrome
늑골 슬립 증후군
Hypermobility/subluxation of 8th–10th false rib cartilage producing pain
- How common
- Underdiagnosed cause of chronic thoracoabdominal pain
- Typical age
- Ages 20–40 (female predominant)
What is it?
Fibrous interchondral attachments of false ribs loosen, allowing rib tips to slip and irritate intercostal nerves.
Commonly affected: 8th–10th (false/floating) ribs
How it develops
- Ligamentous InjuryTrauma or repetitive strain weakens interchondral ligaments
- Rib HypermobilityFree rib tips become mobile
- SubluxationRib slips up and impinges on neighbor
- Intercostal Nerve IrritationNerve entrapment produces radiating pain
Symptoms
- Worse with rotationWorsens with trunk rotation or bending
- Flank/upper abdominal painPain at lower rib margin
- Clicking/slipping sensationAudible/palpable clicking with motion
- Breath-related painMay worsen with deep inspiration
- Mistaken for GI symptomOften misdiagnosed as GI/gallbladder disease
How it is examined
- Hook maneuverFingers hooked under costal margin with upward pull reproduces pain/click
- Focal tendernessTenderness over 8th–10th rib tips
- Palpable rib motionHypermobility palpable with motion
- Normal abdominal examNormal abdominal findings
Imaging
Static X-ray usually normal; diagnosis is clinical and dynamic ultrasound.
- Normal findings
- Exclude other rib pathology
- Exclude fracture
Dynamic US during hook maneuver shows rib subluxation; MRI adjunctive.
- Dynamic US: rib subluxation
- Interchondral instability
- MRI: perichondral inflammation
Non-surgical care
- Reassurance/activity modificationAvoid triggers; reassure benign
- NSAIDsPain/inflammation control
- Physical therapyCore stabilization, posture correction
- Local injection/nerve blockIntercostal nerve block or local steroid injection
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Refractory to conservative care
Procedures that may be discussed
- Costal cartilage excision
- Intercostal neurectomy
Outlook
Most improve conservatively; surgical excision has high success rate.