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Slipping Rib Syndrome

Causes, Symptoms, Treatments, & Other Resources

Slipping Rib Syndrome Goes By Many Names

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.

Anatomical review:

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
  • Difficulty breathing
  • 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…

Read More About Arm Pain at Night

Left Arm Numbness

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…

Read More About Left Arm Numbness

Does Slipping Rib Syndrome show up on X-ray?

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.

non-image-guided method

Upside….

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.

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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…

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John Schultz, MD

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.

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John Pitts, M.D.

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.

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Jason Markle, D.O.

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.

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Matthew William Hyzy, D.O.

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…

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Brandon T. Money, D.O., M.S.

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…

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Mairin Jerome, MD

Mairin Jerome, MD

Dr. Mairin Jerome is a physiatrist with subspecialty fellowship training in Interventional Orthopedics and Regenerative Medicine. This subspecialty serves to fill the gap for patients who are interested in therapeutic options that lie between conservative treatment and surgery. Dr. Jerome uses regenerative medicine techniques, including prolotherapy and orthobiologics, via X-ray or ultrasound guidance to precisely deliver injections to areas of musculoskeletal injury or degeneration. Orthobiologics refers to tissue harvested typically from a person’s own body, such as platelets (platelet-rich plasma, PRP) or bone marrow, for use in treating painful musculoskeletal conditions. The goal is to stimulate the body’s healing mechanisms to improve pain, function, and decrease inflammation.

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Other Resources for Slipping Rib Syndrome

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.

  • Anterior Longitudinal Ligament: Could This Be Responsible for Your Ongoing Neck Pain?

    The neck pain is unrelenting, and all started after being rear ended at a stoplight. Spine X-rays demonstrated some abnormal movement of the Spinal bones.  Both conservative care and medications have failed.  Your doctor thinks you have injured a Spinal ligament.  What is the Anterior Longitudinal Ligament?  What is the role of the Anterior Longitudinal … Continued


  • What Is the Alar Ligament?

    Introduction Medicine is highly specialized now.  Each specialty has a series of checkboxes that patient’s symptoms nicely fit into.  For example, irregular heart rhythm with abnormal ECG is a cardiology problem.  Shortness of breath with abnormal chest x-ray can be effectively evaluated and treated by a pulmonologist.  Unfortunately, the symptoms and presentation of patients with … Continued


  • Differences Between a Normal vs Abnormal Cervical Spine MRI

    The neck pain was unrelenting and unresponsive to conservative care.  Simple tasks and motions were impossible.  At times there were sharp, shooting pains radiating down your arm with accompanying numbness and tingling. Your doctor ordered a Cervical MRI and you are awaiting the results.  What is a Cervical MRI?  How does an MRI work? Does … Continued


  • Grabb Oakes Measurement: How Is It Determined?

    The headaches, brain fog and dizziness were getting worse and unresponsive to conservative care.  You were referred for surgical evaluation.  During the consultation time was spent reviewing your neck MRI.  Different measuresurements were performed.  Should you be concerned?  What is the Cranium?  What is the Craniocervical junction (CCJ)? What is the Grabb Oakes Measurement?  How … Continued


  • Craniocervical Instability & Ehlers Danlos Syndrome: Know the Facts

    Gymnastics and yoga were easy as you were super flexible.  With continued training your shoulders and knees kept popping out of place.  A series of small but significant traumas left you sidelined both from athletics, academics and socially.  Brain fog and fatigue were common themes.  You have seen countless physicians with conflicting information.  Your chiropractor … Continued


  • What Are the Long Term Effects of Untreated Whiplash?

    You were waiting for the red light to change when you heard the brakes screeching. Out of nowhere a large SUV rear ends you and pushes your vehicle into the intersection.  Your neck and shoulder hurt and you’re not processing all the information.  Your doctor thinks you have Whiplash.  What is Whiplash?  What are the … Continued


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1. Turcios NL. Slipping Rib Syndrome: An elusive diagnosis. Paediatr Respir Rev. 2017;22:44-6.                                                https://www.ncbi.nlm.nih.gov/pubmed/27245407

2. Peterson LL, Cavanaugh DG. Two years of debilitating pain in a football spearing victim: slipping rib syndrome. Med Sci Sports Exerc. 2003;35(10):1634-7.

3. Udermann BE, Cavanaugh DG, Gibson MH, Doberstein ST, Mayer JM, Murray SR. Slipping Rib Syndrome in a Collegiate Swimmer: A Case Report. J Athl Train. 2005;40(2):120-2.

4. Kaczynski J, Dillon M, Hilton J. Superior subluxation of an anterior end of the first rib in a trauma patient. BMJ Case Rep. 2012;2012:bcr0220125796.
https://www.ncbi.nlm.nih.gov/pubmed/22669858

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

6. Hevesi M, LaPrade M, Saris DBF, Krych AJ. Stem Cell Treatment for Ligament Repair and Reconstruction. Curr Rev Musculoskelet Med. 10.1007/s12178-019-09580-4
https://www.ncbi.nlm.nih.gov/pubmed/31625113

7. Sit RWS, Wu RWK, Law SW, et al. Intra-articular and extra-articular platelet-rich plasma injections for knee osteoarthritis: A 26-week, single-arm, pilot feasibility study. Knee. 10.1016/j.knee.2019.06.018
https://www.thekneejournal.com/article/S0968-0160(19)30159-0/pdf

Wait! Did you get your free download of The Spine Owner's Manual?

This book is full of tests and exercises to understand what is happening to cause your orthopedic pain. 

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