Slipping Rib Syndrome

Slipping rib syndrome is a medical condition where one or more of the lower ribs become hypermobile, often resulting in pain and discomfort. This occurs when the cartilage that connects the ribs to the sternum or to each other becomes weak or damaged, allowing the ribs to move or slip out of their normal position and push on the nerve. 

Slipping rib syndrome is a straightforward condition with potentially severe consequences for those affected. Without proper diagnosis and treatment, it may lead to long-term disability and chronic pain.

• Pain in the lower chest or upper abdomen, often described as sharp or stabbing.
• A feeling of "popping" or "clicking" in the ribs.
• Pain that worsens with certain movements, such as twisting or bending.
• Sometimes, the pain radiates to the back or shoulder.

• Clinical examination where a doctor may try to reproduce the symptoms by applying pressure to the ribs.
• Imaging tests such as CT scans, X-rays, MRI or ultrasound may be used, although they are often reported as normal.
• Diagnostic injections of local anesthetic can help confirm the diagnosis if unclear by physical examination.

Non-interventional treatments such as rest, avoiding aggravating activities, physical therapy and pain management with medications or injections.

In cases where conservative treatments fail, surgical options may be considered. Surgery typically involves removal of the offending cartilage and stabilization of the affected ribs to prevent recurrent of nerve impingement.

Costal margin reconstruction is the newest surgical option.

Costal margin reconstruction is a significant advancement in surgical options for SRS and is performed by Dr. Taylor Ripley at Baylor Medicine in Houston. This latest technique involves removing the problematic cartilage, cutting it into small pieces and putting those pieces of your own cartilage between your ribs (autortransplant) to keep them spaced appropriately. The cartilage and ribs are secured with sutures and a bioabsorbable plate. This plate along with the sutures allows stability while the repair is healing but maintains flexibility so that normal breathing and activity is not impaired.  

This procedure not only offers pain relief but also reduces the need for revisional operations and dependency on pain medications while enhancing the overall quality of life for patients.

Costal margin reconstruction is the most advanced technique currently available and is offered at Baylor Medicine. However, you may hear about other approaches:

• Sutured repair: This repair involves the surgeon stitching the ribs together. The results from this method are initially good but over time the suture repairs break down with recurrence of symptoms.
• Costal cartilage excision: This involves removing the cartilage that led to the pain, but often the motion of the ribs leads to recurrence of pain. A bridging plate may be used to stabilize the ribs.