Slipping Rib Syndrome Diagnosis and Treatment

Slipping rib syndrome is a musculoskeletal disorder characterised by excessive mobility of the eighth to tenth ribs, which are bound to each other by interchondral ligaments rather than directly to the sternum. Patients typically present with sharp, intermittent pain in the lower chest or upper abdomen, often exacerbated by twisting movements, deep inspiration or certain postures. Diagnosis is primarily clinical, relying on careful history and physical examination; a positive hooking manoeuvre—where gentle upward traction on the costal margin reproduces the pain—is considered pathognomonic. Dynamic ultrasound has emerged as a valuable adjunct to confirm rib displacement by visualising aberrant rib motion in real time. Initial management comprises reassurance, activity modification and analgesia. In cases that fail conservative measures, targeted intercostal nerve blocks or minimally invasive surgical options may be employed. Surgical techniques range from costal cartilage excision to rib fixation procedures using plates or sutures, aiming to stabilise the hypermobile segment. More recently, percutaneous nerve ablation techniques have been trialled to provide long-term pain relief without the risks associated with open surgery. A multidisciplinary approach integrating physiotherapy, pain management and surgical expertise has proven effective in reducing diagnostic delays and improving patient outcomes.

Research from Nature Portfolio

No recent Nature Portfolio content available.

Slipping Rib Syndrome Diagnosis and Treatment publication trend

The graph below shows the total number of articles in slipping rib syndrome diagnosis and treatment across all publications each year (not limited to Nature Index journals).

Technical terms

Slipping Rib Syndrome: Condition characterised by hypermobility of the lower ribs leading to episodic pain in the lower chest and upper abdomen.

Hooking manoeuvre: Physical examination technique in which gentle upward pressure beneath the costal margin reproduces pain by eliciting rib excursion.

Dynamic ultrasound: Real-time imaging method used to visualise rib movement and ligament laxity during respiratory or manual provocation.

Costal cartilage excision: Surgical removal of unstable rib cartilage to eliminate aberrant motion and relieve pain.

Intercostal cryoneurolysis: Minimally invasive procedure applying extreme cold to intercostal nerves to induce reversible axon disruption for sustained analgesia.

References

1. Slipping Rib Syndrome in a Female Adult with Longstanding Intractable Upper Abdominal Pain. Case Reports in Medicine (2018).
2. A Review of Slipping Rib Syndrome: Diagnostic and Treatment Updates to a Rare and Challenging Problem. Journal of Clinical Medicine (2023).
3. Treatment of Chronic Pain Due to Slipping Rib Syndrome Using Ultrasound‐Guided Intercostal Cryoneurolysis: A Case Report. Case Reports in Anesthesiology (2025).