Slipping Rib Syndrome

The slipping rib syndrome pertains to a rib that slips out of place. It is also called Tietze’s syndrome. With this condition, the ligament that supports the back and front of the rib stretches out causing pain in the chest area.

This condition usually involves the tenth rib because this rib isn’t directly attach to the sternum. This condition can be very painful that even a simple laugh and cough can trigger pain. ⁽³⁾

Causes of Slipping Rib Syndrome

Slipping rib syndrome’s exact cause is still unknown up to this time. However, it can be associated with inflammatory disease and trauma to the rib cage. Anything that can cause stress or pressure to the rib cage may contribute to the development of slipping rib syndrome such as excessive coughing, viral infection, and the likes. ⁽⁴⁾

Image 1 : A clinical representation of slipping rib syndrome
Photo Source : syndromespedia.com

Picture 2 : A health practitioner performing a slipping rib syndrome hooking maneuver to a patient suspected of a slipping rib syndrome
Photo Source : www.practicalpainmanagement.com

Slipping Rib Syndrome Symptoms

How do you know if a rib is out of place? You will know if something is wrong in your ribs if you experience the following symptoms:

• You will complain of chest pain. In the acute phase of the syndrome, the chest pain is intense. Any activities that stress the chest can lead to intense chest pain.
• Labored breathing
• A feeling of pressure in the chest
• Chest pain when sneezing, coughing, or swallowing
• Swelling in the chest area
• Pain in the chest area that extends to the arms, neck, and shoulders
• The pain is dull or sharp in nature, a feeling like your chest is stabbed with a knife ⁽⁴⁾

The chest pain caused by slipping rib syndrome can be mistaken for a heart attack, which makes the diagnosis quite difficult. With the slipping rib syndrome, the chest pain only affects a small portion of the chest. In a heart attack, the chest pain covers the entire chest. You will know if you have a heart attack if the chest pain has other symptoms like nausea, sweating, and shortness of breath.

What is a rib-tip syndrome?

It is the pain felt in the flank area, just right at the top of the hip bone. The pain occurs when the lowest rib touches the area of the iliac crest. It is also known as costo-iliac impingement syndrome. The rib tip syndrome usually affects the elderly, especially those who have scoliosis (curved spine).

As the spine curves, the tip of the lowest rib gets in contact with the iliac crest, which causes pain and discomfort. This could also happen to people with osteoporosis. ⁽⁵⁾

What is a rib subluxation?

This is a type of rib injury, which is very common but less painful. It occurs when the rib or a set of rib are partially displaced.

It is caused by a sudden jerking movement that causes pressure on the ribs such as a simple exercise that includes arms being pulled to the back of the body, sleeping in improper position, flu symptoms (coughing and sneezing), and lifting heavy objects. ⁽⁶⁾

How to diagnose a slipping rib syndrome?

Slipping rib syndrome can be quite difficult to diagnose because it can be mistaken to a heart attack and other problems. It can be mistakes to angina (chest pain secondary to lack of oxygen in the heart muscles), chest wall pain, rheumatoid arthritis, lung problems, and slipping rib syndrome costochondritis.

To come up with the right diagnosis, the doctor will thoroughly assess the symptoms of the patient. He will perform a thorough physical examination particularly in the chest area. Additional tests will be ordered to rule out other things such as an x-ray, MRI (magnetic resonance imaging, ultrasound, ECG (electrocardiogram), biopsy, and slipping rib syndrome hooking maneuver.

In this test, the patient lies on the unaffected side and the therapist will hook his fingers under the lower costal margin and gently pull the rib anteriorly. If a clicking sound is heard and the patient complains of pain, it confirms that the patient does have a slipping rib syndrome. ^{(1, 2, 10)}

Slipping Rib Syndrome Treatment

There are various forms of slipping rib syndrome treatment. The focal point of the treatment is to significantly improve the condition of the patients.

Drug Therapy

Slipping rib syndrome is usually treated using non-steroidal anti-inflammatory drugs. It is believed that this condition is caused by inflammation in the constochondral junction. Anti-inflammatories and pain relievers can help alleviate the pain. ⁽⁵⁾

Chiropractic Approach

Through chiropractic method, a slip rib will be able to place back to its original location. The chiropractor will manipulate a portion of the spine to bring back to its normal state. This procedure is very delicate though and should only be performed by professionals. A single mistake could lead to irreversible damage to the ribs and spine. ⁽⁶⁾

Physical Therapy

Physical therapy is one of the best way to address slipping rib syndrome pain. The goal of the therapy is to strengthen the muscles that hold the ribs together. A significant part of the therapy is performing various slipping rib syndrome exercises.

These include segmental breathing exercise, stretching exercises, seated rotation exercise, alterative chest expansion and compression exercises. A combination of these exercise routines can hasten the healing of the ribs. ⁽⁷⁾

Lifestyle Modification

People with slipping rib syndrome should perform mild and momentary activities to improve the condition and at least prevent the occurrence of slipping rib syndrome. Activities that cause stress to the chest area should be completely avoided. Keep your body hydrated. Eat foods rich in essential nutrients to keep your body healthy and build muscle strength. As much as possible, you should avoid sneezing, laughing, or coughing too hard. ⁽⁸⁾

Surgical Approach

Slipping rib syndrome surgery should be the last resort and is only done in extreme cases.

Recovery Period

The recovery period could take days to years. It depends on the treatment approach used. Slipping rib syndrome exercises when done right and rigorously could show improvement after a few weeks or months. As with the chiropractic approach, you will see improvement in a matter of weeks. For the surgical approach, it usually takes weeks to months for the patient to completely recover from the illness. ⁽⁹⁾

References:

1. http://www.physio-pedia.com
2. www.livestrong.com
3. www.doctorshealthpress.com
4. https://syndromespedia.com
5. www.tandurust.com
6. www.irvinespinesurgeon.com
7. https://rarediseases.org
8. www.medicinenet.com
9. www.webmd.com
10. www.healthline.com