Slipping Rib Syndrome

Ribs are flat, thin bones that make up the ribcage (together with the sternum). They play a vital role in the body. The ribs provide protection for important organs in the upper body, especially the heart and lungs.

They also protect the important blood vessels in the upper body. The total pair of ribs in the human body is 12. However, ribs vary in size and how they are connected to the front of the skeleton.

There are three types of ribs:

• True ribs – They are directly attached to the sternum (1 to 7th ribs).
• False ribs – They are connected to each other through cartilaginous band (8th to 10th ribs).
• Floating ribs – They are not attached to the sternum and are the smallest of all the rib bones. They are not connected to the front instead they are connected to the spin at the back. ^{(1, 2)}

Image 1: The human anatomy of the ribs
Picture Source: humananatomylibrary.com

Photo 2: The human ribs outlining the true ribs, false ribs, and floating ribs.
Image Source: image.slidesharecdn.com

Image 2: An image of the ribs outlining the slipping rib point.
Picture Source: syndromespedia.com

What is a slipping rib syndrome?

It is a condition in which one of the ribs slips out of place. It usually affects the false ribs specifically the 10th rib because of its weak connection and susceptibility to trauma.

Its location is also one of the contributing factors for slipping rib syndrome considering the fact that it is not directly connected to the sternum. Slipping rib syndrome is also called Tietze’s syndrome. ^{(2, 3)}

Slipping rib syndrome affects about 40% of the general population during the lifetime. There are various reasons why slipping rib syndrome happens. They include the following:

1. Hypermobility of the rib cartilage of both the floating and false ribs.
2. History of abdominal surgery
3. Poor posture
4. Injury to the chest wall such as in contact sports ⁽¹⁰⁾

Slipping rib syndrome symptoms

• Severe pain in the lower chest or just above the upper abdomen up in the costal margin.
• Tender spot commonly found on the costal margin.
• Pain is felt when the tender spot is pressed.
• The pain is usually unilateral but there are also instances when the pain is bilateral.
• The patient describes the pain as intermittent sharp stabbing pain and will be followed by monotonous pain that could last for several hours to weeks.
• The pain can be extremely intense to the point that it will interfere with activities of daily living.
• The pain is exacerbated by posture and movement such as lying in bed, driving, stretching, or rising from the chair.
• The intercostal nerve is irritated and the intercostal muscle is strained because of the slippage and movement of the ribs.
• The patient may complain of a popping, giving away, or clicking sensation. ^{(4, 5, 6)}

Diagnostic Procedures

To accurately diagnose slipping rib syndrome, a variety of tests should be performed. They include the following:

• Sonography – This procedure can accurately diagnose Sonography. This procedure uses a high frequency linear probe to precisely visualize the luxation of the cartilaginous rib. It is triggered by Valsalva maneuver. It can also detect other related conditions like fracture of the ribs, muscle tear, and abdominal disease.
• Radiologic investigation – It is used to exclude other related conditions.
• Physical examination – The affected area will be palpitated to locate the tender spot and if pain is felt during palpitation. It is called slipping rib syndrome hooking maneuver. This was first described in 1977. It is a simple test that can accurately detect slipping rib syndrome. Valsalva maneuver can also be used to accurately diagnose slipping rib syndrome. ^{(4, 5, 7)}

Slipping Rib Syndrome Treatment

The treatment for slipping rib syndrome is vast. It uses a multidisciplinary approach.

Pain Relief

One of the primary complaints of patients with slipping rib syndrome is pain. Hence, pain management is a crucial part of the treatment, there are various ways to alleviate the pain such as giving long acting steroid and nerve block. Analgesics can also be given to the patient. ^{(8, 9)}

Rib Excision

In some instances, a rib excision is required. It is a slipping rib syndrome surgery in which the anterior end of the rib and costal cartilage is removed. An incision is made along the costal margin, which mostly involve the eighth, ninth, and tenth ribs. ^{(8, 9)}

Physical Therapy

• The patient is taught of ways to avoid movements that can negatively affect the ribs and other parts of the body. The pain should not be triggered by any movement.
• Manual therapy with the help of a physical therapist or chiropractor can prove helpful in the management of slipping rib syndrome. The chiropractor will manipulate the costovertebral joint and electrically stimulate the ribs thereby managing the pain and long term relief of the slipping rib syndrome. Slipping rib syndrome exercises are also proven helpful in the pain relief and management of slipping rib syndrome. However, the type of management is dependent on the type and intensity of pain. In case of moderate pain, the patient is advised to wear an elastic bandage around the thorax for about one to two weeks. ^{(6, 7, 8)}

Lifestyle Modification

Patients with slipping rib syndrome should modify their lifestyle. Patient should not engage in strenuous forms of activities in order to prevent pain and discomfort. Avoid any activities that can be stressful to the chest area such as sneezing, laughing, and coughing too hard.

It is a must to eat healthy and nutritious foods. The doctor will suggest activities that can strengthen the muscles without pressing stress on the ribs. ^{(2, 3)}

Slipping Rib Syndrome Recovery Period

The recovery period for slipping rib syndrome varies depending on the overall condition of the patient. Some patients were able to recover in a few weeks while others take months and even years. The effect of slipping rib syndrome exercise can be felt after a few weeks or months of religious exercise.

On the other hand, chiropractic procedures would only take a few weeks for the patients to see a significant improvement. In the case of surgical procedure, it would take weeks to months for the patients to fully recover. ^{(1, 4, 5)}

References:

1. https://www.healthline.com/health/slipping-rib-syndrome
2. https://www.physio-pedia.com/Slipping_rib_syndrome
3. https://www.epainassist.com/chest-pain/ribs/slipping-rib-syndrome
4. https://www.livestrong.com/article/11811-way-diagnose-slipping-rib-syndrome/
5. http://www.sciencedirect.com/science/article/pii/S2210261216300670
6. http://www.phoenixchildrens.org/medical-specialties/pediatric-surgery/slipping-rib
7. https://syndromespedia.com/slipping-rib-syndrome.html#.Wd3IIvmCzIU
8. http://slippingribsyndrome.com/what-is-slipping-rib-syndrome/
9. https://www.caringmedical.com/prolotherapy-news/slipping-rib-syndrome/
10. https://www.doctorshealthpress.com/general-health-articles/slipping-rib-syndrome-causes/