Pain beneath the ribs that returns when you turn over in bed, bend forward or take a deep breath, sometimes with a clicking, catching or slipping sensation, may be a sign of slipping rib syndrome (SRS). Many tests may have been done without explaining the source of the pain. The problem is not always an abnormality visible on a static image; in some patients, pain occurs when the rib cartilage shifts relative to neighbouring structures during movement.
What is slipping rib syndrome?
The cartilage connections at the front of the lower ribs form the costal margin, the lower border of the rib cage. In slipping rib syndrome, weakness of these connections, most often around ribs 8, 9 and 10, can lead to abnormal mobility. This movement can irritate the nerve running between the ribs and cause pain.
Patients may describe a stabbing sensation at the rib tip, sharp upper abdominal pain, an ache in the side, or discomfort extending to the back. Not every patient has a noticeable click, and a clicking sensation alone does not establish the diagnosis.
Which symptoms warrant assessment?
Particularly when recurrent and linked to movement, the following may warrant investigation of rib-related causes during the clinical examination:
- Pain localised to a specific point along the lower rib margin or in the upper abdomen,
- Discomfort that increases with twisting the torso, bending, coughing or certain exercises,
- A slipping, catching or clicking sensation beneath the ribs,
- Frequently changing sleeping positions and avoiding everyday movements because of pain.
These symptoms can have other causes. Conditions involving the heart, lungs, digestive system, spine and muscles are considered according to the patient's history. A normal test result does not mean the pain is not real, nor does it on its own establish a diagnosis of slipping rib syndrome.
Why can diagnosis be delayed for years?
The absence of pain during examination, symptoms felt in different areas, and the inability of routine imaging to show movement can prolong the diagnostic journey. Over time, recurring pain affects not only the body but also sleep, working life and a person's confidence in their own body. Many patients arrive after years of symptoms and numerous consultations across different specialties. The medical literature reflects this: in a study of 435 patients by Hansen and colleagues, the reported median time spent seeking a diagnosis or relief was 36 months, and the number of physicians consulted was six.
Clinical examination and dynamic ultrasound
Assessment begins with a discussion of where and when the pain started and which movements trigger it. Examination findings are then considered alongside the symptoms the patient describes. When needed, dynamic ultrasound helps show how the ribs move in relation to one another during selected movements. Simply observing movement is not enough: it is also necessary to assess whether the observed movement corresponds to the patient's familiar pain at the same location and at the same time.
MRI, CT or standard ultrasound may be valuable for investigating other conditions. However, when a problem is related to movement, normal findings on previous imaging do not, on their own, bring the assessment to an end. Likewise, seeing movement on dynamic ultrasound does not automatically mean that surgery is needed.
Treatment options
Treatment decisions depend on the severity of symptoms, their impact on daily life, examination findings and rib anatomy. Not every patient needs surgery. Activity modification, appropriate pain management, individually tailored rehabilitation and, in selected cases, injections may be considered.
Surgical options include cartilage excision, suture stabilisation and costal margin reconstruction. The choice of technique depends on the patient's anatomy. Removing a rib or cartilage may benefit some patients, but removal does not always resolve the remaining abnormal mobility, and some patients need reassessment because of persistent instability or pain. See the Costal Margin Reconstruction page for more detail.
Frequently asked questions
Which doctor should I see for slipping rib syndrome? A thoracic surgeon with experience in chest wall conditions and slipping rib syndrome can carry out an assessment. Depending on the symptoms, input from other specialties may also be needed.
Can I have this syndrome even if my CT or MRI is normal? Yes. Problems related to movement may not always be visible on routine imaging. Diagnosis is based on the combined assessment of the medical history, clinical examination and, when needed, dynamic ultrasound. A normal imaging result alone neither confirms nor rules out the diagnosis.
Does every patient need surgery? No. The decision takes into account how much the pain affects daily life, the treatments already tried and the structural problem identified.
Can I be reassessed if I have already had rib cartilage removed? Yes. The possible cause of pain can be investigated by reviewing the previous surgical report and the current anatomy. Whether revision surgery is appropriate is determined individually; another operation is not necessary or beneficial for everyone.
Appointments and further information
Before an assessment, it helps to note how long the pain has been present and which movements bring it on. Previous test results, treatments and any surgical reports also contribute to planning. To arrange an appointment, please use our contact page. More information on this topic is available at drpectus.com.
This page is for general information only and does not replace a personal examination or medical advice.