Could Slipping Rib Syndrome Be Causing Your Back Pain?

Slipping rib syndrome is a painful and rare disorder that is known by many other names, including floating rib syndrome, lost rib syndrome, costal chondritis or costochondritis, and Tietze syndrome.

Slipping rib syndrome is a rare disorder that is known by many other names, including floating rib syndrome, lost rib syndrome, costal chondritis or costochondritis, and Tietze syndrome (for the German surgeon who discovered it). Costal chondritis, costochondritis and Tietze syndrome are sometimes used interchangeably and characterized by inflammation of the part of the rib that is cartilage.  

Though its various names appear to have nothing to do with the spine, slipping rib syndrome can cause severe back pain in your thoracic spine—or your middle back when one of your ribs shifts out of normal position. In some patients, chest wall pain is the foremost symptom. This article provides you with the basics about back pain potentially caused by slipped rib syndrome, including symptoms and when you should call your doctor.
Rib cage labeledKey anatomical structures of the human body’s rib cage related to slipped rib are illustrated. Photo Source:

Slipping Rib Syndrome’s Connection to the Thoracic Spine and Pain

To better understand slipping rib syndrome and how it may develop, a quick review of the related anatomy is needed. First, you have 12 sets of ribs; one set on each side of your body. Starting at the top, the first set of ribs attach to the first thoracic vertebra (T1), and the remaining ribs make attachments down to T11. Costovertebral ligaments attach the ribs to the thoracic vertebrae.

The first 7 rib sets are connected to the thoracic vertebrae in your back and the sternum (breastbone). In the front of the rib cage and between the ribs are costochondral joints and costal cartilage. These ribs are referred to as true ribs. The cartilage is elastic and allows for expansion of the rib cage such as when taking a deep breath.

The remaining 5 ribs are false ribs. This refers to the fact that ribs 8-10 are not connected to the sternum but by a fibrocartilaginous band from the rib above. The last 2 ribs have no connection at the front of the body and are sometimes called floating ribs. That’s why these lower ribs are most often involved in slipping rib syndrome.

Another anatomical feature involves the thoracic spine’s facet joints, of which there are 24 (12 on either side at the back of each thoracic vertebrae). When a rib slips at T10 or T11, there is an opportunity for facet joint involvement that can cause considerable pain.

Slipping Rib Syndrome Causes and Risk Factors

In some people, there is an inherited risk for slipping rib syndrome. However, it’s more often caused by an injury. Traumatic injury to your rib cage, such as from physical violence—a fall, or auto accident—may result in the condition. As such, engaging in contact sports is a risk factor.

Slipping rib syndrome may also be caused by chest problems and illnesses, including asthma, bronchitis, or a severe, long-lasting cough. While slipping rib syndrome is associated with several causes, there may be no obvious cause for why it occurred.

Symptoms of Slipping Rib Syndrome

One slipping rib syndrome symptom is back pain.1 Symptoms occur when the abnormal rib movement irritates surrounding nerves and muscles, triggering inflammation and pain.

In addition to back pain, people with slipping rib syndrome also report:

  • Abdominal pain that is intense initially, but eventually subsides to an ache
  • A “popping" or "clicking" sensation in the rib cage area
  • Difficulty breathing or coughing
  • Pain with certain activities that move the rib cage, such as bending

When to See Your Doctor

Some slipping rib syndrome symptoms are not only painful, but they can be life threatening. Seek immediate medical care if you have difficulty breathing or experience chest pain, as this may indicate a serious medical emergency.

If your pain shows no signs of subsiding and/or if symptoms are interfering with your ability to perform daily tasks, see your doctor as soon as you can. Getting a proper diagnosis will put you on the right treatment path to help relieve your pain.

How Slipping Rib Syndrome Is Diagnosed

Slipping rib syndrome’s symptoms mimic those of other conditions, so it can be a challenge to diagnose properly. Your spine specialist or personal doctor will begin the diagnostic process by asking you about your symptoms—how long you’ve had them, and what worsens or eases them. Your evaluation also involves a careful review of your medical history.

Your doctor will conduct a physical exam, which can reveal if a rib is not properly positioned with your other ribs. If your doctor finds a rib out of alignment, he or she may perform the “hooking” or “hook” maneuver. With this maneuver, the doctor gently moves the misaligned rib to determine if it causes pain, and if it makes a clicking sound.

While your doctor may order imaging tests (such as an x-ray) to rule out other conditions, the hooking maneuver may be enough to confirm a slipping rib syndrome diagnosis.

NonSurgical Treatments for Slipping Rib Syndrome

If your slipping rib syndrome is considered mild or moderate, conservative treatment is usually enough to relieve pain. Your doctor may recommend one or a combination of the nonsurgical treatments below:

  • Rest
  • Cold and heat therapy
  • Medication to relieve pain and inflammation, such as a non-steroidal anti-inflammatory drug (NSAIDs)
  • Physical therapy

In addition to the therapies above, your doctor may prescribe the following to manage pain:

  • Epidural corticosteroid injection or intercostal nerve block to ease inflammation and pain
  • Botulinum toxin therapy (also known as Botox) for muscle pain
  • Massage
  • Prolotherapy to strengthen weakened ligaments
  • Ultrasound therapy to reduce muscle inflammation

Surgery for Slipping Rib Syndrome

If your chest wall and mid-back pain is severe and has not responded to non-surgical treatment, surgery for slipping rib syndrome may be an option for you. The surgical procedure for slipping rib syndrome is called costal cartilage resection or excision. This involves removing the slipped rib and the connecting costal cartilage.

Life with Slipping Rib Syndrome

Like so many medical conditions, getting an accurate diagnosis as early as possible is a key to long-term treatment success. Don’t wait to see your spine specialist or personal doctor if you’re experiencing severe middle back or chest pain. Different treatments and therapies can help relieve the pain of slipping rib syndrome, allowing you to engage in your life and the activities that enrich it.

Updated on: 01/09/20
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