Slipping Rib Syndrome can be incredibly painful and is often misdiagnosed. It’s also known as rib dislocation, rib subluxation, Tietze syndrome, Davies–Colley’s syndrome, rib-tip syndrome, painful rib syndrome, costochondral separation, and clicking or moving rib syndrome.
The rib cage is made up of 24 total ribs, with 12 on each side, and these ribs connect to the vertebral column at the back of the rib cage, and connect to the sternum which is the chest plate, at the front of the rib cage. The ribs are connected to the spine (costo-transverse joint) and sternum (costo-chondral joint) through a network of ligaments, with the exception of the bottom two ribs on each side known as floating ribs, because they only connect to the spine and do not connect to the sternum.
Ribs become slipping ribs due to hypermobility (too much motion) of the ribs at their attachment sites. The underlying issue is thought to be due to damaged or stretched ligaments that connect the ribs to both the spine and sternum (1). This is commonly caused by seat belt injuries in car accidents, and collisions in contact sports.
What does a rib out of place feel like And can a Slipped Rib cause back pain?
Slipping ribs can create many different types of pain. Common symptoms are:
Intermittent sharp stabbing pain in the upper abdomen or back, followed by a dull, achy sensation
Intermittent sharp stabbing pain in the upper back, mid-back, or even lower back
Slipping, popping, or clicking sensations in the lower ribs
Numbness in the arm or numbness around the chest or abdomen
Worsening of symptoms when bending, lifting, coughing, sneezing, deep breathing, stretching, or turning in bed
Since ribs can cause many different symptoms, it is not uncommon for patients to have multiple unnecessary diagnostic tests to rule out problems with heart, lungs, stomach, gallbladder or kidneys before finally getting diagnosed with rib dysfunction (1). Many patients have seen multiple physicians through multiple specialties (cardiologists-heart doctor, gastroenterologists-stomach doctor, pulmonologist-lung doctor). Scott found that as high as 3% of all patients that see a gastroenterologist (GI doctor) have rib instability as the cause of their symptoms.
Common Symptoms of Slipped Rib Syndrome
Arm Pain at Night
Arm pain at night can be miserable. The pain can interrupt your sleep and erode your quality of life. Irritability becomes increasingly more common. What are the causes? When should I worry about it? What are the treatment options for arm pain at night? The neck is composed of 7 boney building blocks numbered 1- 7. Sandwiched between the bones is a disc that functions as an important shock absorber. The cervical discs are susceptible to injury due to trauma, degeneration, repetitive motion, and surgery. Common disc injuries include disc bulges, and herniations. The injured disc can compress or irritate one or more nerves resulting in arm pain at night. It can…
Treatment depends upon the underlying cause of the arm numbness. Left-arm numbness is a warning sign that requires attention. As noted above unexplained numbness requires immediate attention. At the Centeno-Schultz Clinic, we are experts in the treatment of left-arm numbness due to cervical nerve irritation, cervical stenosis, thoracic outlet syndrome, and peripheral nerve injuries. When appropriate first-line treatment should involve conservative care including physical therapy and stretching. Steroid injections should be avoided as they are toxic to orthopedic tissue and can accelerate damage. Surgery for Cervical Stenosis and Thoracic Outlet Syndrome is major surgery and associated with significant risks. These risks…
The condition is characterized by hypermobility at the sternocostal, costochondral, or rib-vertebral sites caused by weakness or damage of the associated ligaments (2, 3). This condition does NOT show up on x-rays and typically a diagnosis through exclusion.
The diagnosis is made by a simple clinical test-hooking maneuver, during which the clinician’s fingers are placed under the affected rib margin and pulled forward. If this reproduces the pain, clicking or a moving sensation the test is positive (4).
Causes of Slipped Rib Syndrome
It’s very common for athletes involved in contact sports to get a slipped rib. Trauma causes stretching and sometimes tearing of the ligament attachments of the rib, creating instability. We also see this in many of our motor vehicle accident patients, caused by the seat belt and/or airbag.
How long does it take for a slipped rib to heal?
Once damaged, it can take several weeks to resolve (4-12 weeks). After 3 months, if the rib continues to be problematic it’s unlikely that it will heal on its own.
Can a chiropractor fix a slipped rib? How do you treat a slipped rib?
As an Osteopathic Physician, I have extensive training in manual medicine and manipulation techniques. If a rib is dislocated and causing pain, the simple treatment would be a single small adjustment to re-locate the rib. The problems arise when the rib then subsequently goes back out of place and needs continuous adjustments weekly, or in some cases daily.
A New Treatment Approach: Perc-Orthobiologic Rib Stabilization (PORS)
Prolotherapy, platelet-rich plasma, and in some cases bone marrow concentrate, can be used to treat this condition. If the underlying problem is hypermobility of the ligaments that control the rib, why not treat these ligaments with something that can strengthen the ligaments, effectively reducing the hypermobility? Prolotherapy is a solution of high concentration of glucose (sugar water) that has been utilized for the last century to treat laxity in ligaments (5).
Here is a link describing more about prolotherapy: https://centenoschultz.com/prolotherapy/
In recent years advancement in ligament treatment options have advanced to include both platelet-rich plasma and bone marrow concentrate treatment (6, 7).
While these can be excellent alternatives compared to more invasive surgeries, these injections are not without risks and you need to consider who is able to perform these injections safely and effectively. Many prolotherapists still utilize a “feel and poke” method for injecting.
Click on the link, where Dr. Schultz explains the importance of utilizing the most advanced imagine guidance to allow precise injections into the desired structures.
Please be aware, the risk of complications from blind injections can increase drastically if no direct visualization is used. The advent of musculoskeletal ultrasound has made it possible to visualize soft tissue structures and avoid the things we don’t want to inject (nerves, blood vessels) and directly inject the ligament! These treatments are high-level advanced injections and you need to have the proper training to do these safely – here is a video done by Dr. Centeno explaining interventional orthopedics.
While rib instability can be disabling at times, we have created a treatment option aimed at treating the underlying issue to resolve symptoms and improve function. If you feel you have been dealing with a rib issue, feel free to contact the Centeno-Schultz Clinic to set up an evaluation so we can assess your candidacy for rib stabilization treatment.
Doctors Who Help With Slipping Rib Syndrome
Christopher J. Centeno, MD
Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…
My passion and specialization are in the evaluation and treatment of cervical disc, facet, ligament and nerve pain, including the non-surgical treatment of Craniocervical instability (CCI). I quit a successful career in anesthesia and traditional pain management to pursue and advance the use of PRP and bone marrow concentrate for common orthopedic conditions. I have been a patient with severe pain and know firsthand the limitations of traditional orthopedic surgery. I am a co-founder of the Centeno-Schultz Clinic which was established in 2005. Being active is a central part of my life as I enjoy time skiing, biking, hiking, sailing with my family and 9 grandchildren.
Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.
Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.
Doctor Hyzy is Board Certified in Physical Medicine and Rehabilitation (Physiatry) and fellowship-trained in Interventional Orthopedics and Spine. Dr. Hyzy is also clinical faculty at the University of Colorado School of Medicine in the Department of Physical Medicine and Rehabilitation; In addition, Dr. Hyzy is an Adjunct Clinical Assistant Professor at The Rocky Vista University College of Osteopathic Medicine. Dr. Hyzy also maintains an active hospital-based practice at Swedish Medical Center and Sky Ridge Medical Center. He is also recognized and qualified as an expert physician witness for medical-legal cases and Life Care Planning. He is published in the use of autologous solutions including…
Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…
The Spine Owner’s Manual: How to Avoid Back Pain & Life-Altering Surgery
This e-book from Dr. Chris Centeno focuses on the spine and how it functions within the human musculoskeletal system and the body as a whole. Everything in our bodies works together like a well-tuned symphony to support our well-being, and a strong spine (including all of its component parts, such as spinal nerves, ligaments, muscles, etc.) is critical to complete health.
Using the Regenexx SANS approach, The Spine Owner’s Manual provides a series of tests and clearly defined exercises that you can do on your own to measure and monitor your own spinal health. These musculoskeletal tests will allow you to monitor where your own body might be struggling to maintain proper stability, articulation, symmetry, and neuromuscular function.
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5. Rabago D, Reeves KD, Doherty MP, Fleck M. Prolotherapy for Musculoskeletal Pain and Disability in Low- and Middle-Income Countries. Phys Med Rehabil Clin N Am. 2019;30(4):775-86. https://www.ncbi.nlm.nih.gov/pubmed/31563169