Slipping Rib Syndrome

Slipping Rib Syndrome - What it is

Slipping rib syndrome (SRS) is a rare condition where the rib ‘slips’ or moves excessively, leading to pain in the lower chest or upper abdomen.

In SRS, the cartilage that holds the lower ribs to the ribcage becomes loose or ‘slips’, causing the rib attached to the cartilage to rub against the rib above or below it. This results in pain felt in the upper abdomen or the chest, as the increased movement tend to irritate the nerves of the ribcage.

Due to lack of awareness and under-diagnosis of the condition, patients with SRS may often suffer in pain for long periods of time before receiving appropriate diagnosis and treatment.

Slipping Rib Syndrome - Symptoms

While the condition is rare, one can look out for these early signs and symptoms of slipping rib syndrome:

Intense pain in the lower chest or upper abdomen
A tender spot at the border of the rib, and reproduction of pain when pressing the tender spot
Pain can be sharp or dull, and can last for hours to weeks
Worsening of pain with certain movements such as stretching, twisting the trunk, bending, carrying heavy loads

Slipping Rib Syndrome - How to prevent?

The symptoms of slipping rib syndrome (SRS) can be reduced through proper conditioning and appropriate lifestyle changes.

Patients are also advised to rest and avoid strenuous activities, so as to avoid any strains on the chest area and abdomen.

Slipping Rib Syndrome - Causes and Risk Factors

There is currently no definitive cause for slipping rib syndrome (SRS). However, in most cases, issues such as weakness in chest muscles or ligaments are usually evident. Those afflicted with SRS would often present with increased movement of the lower ribs.

Other possible risk factors of SRS include chest wall anomalies since birth, or injury to the cartilage of the ribs.

Slipping Rib Syndrome - Diagnosis

As slipping rib syndrome (SRS) has similar symptoms to other conditions, your doctor may arrange for scans or tests such as a computed tomography (CT) scan before confirming the diagnosis.

As scans for an individual with SRS may appear normal, your doctor may also perform a specialised bedside examination, called a ‘Hook Manoeuvre’ test.

Hook Manoeuvre nhcs physio
(Above) A ‘Hook Manoeuvre’ can test whether a patient is suffering from slipping rib syndrome.

The test requires the patient to lie flat on his or her back, and the doctor or physiotherapist will place his or her fingers along the edge of the last rib and lift upwards and towards the head of the patient. The test is positive if it causes the patient to experience the same sharp pain or produce a ‘pop’ sound as the rib moves.

Slipping Rib Syndrome - Treatments

As the symptoms of SRS results from increased movements of the chest wall, it is also important to strengthen the muscles around the ribs to reduce these movements and stabilise the chest wall.

Upon diagnosis, patients are provided with a comprehensive treatment plan from the Department of Cardiac Physiotherapy Services at NHCS. The plan would include pain management, such as medications and heat/cooling therapy, and an exercise programme to strengthen rib and oblique muscles. Patients will also be encouraged to do simple stretching and rotation exercises at home, as per instructions given by the physiotherapists.

In severe cases, surgical treatment via a day surgery procedure, may be considered to alleviate the symptoms of slipping rib syndrome (SRS).

Slipping Rib Syndrome - Preparing for surgery

Please follow the below instructions to prepare for your slipping rib syndrome surgery:

Inform your doctor of your current medications as some medicines are unsuitable for consumption before a surgery.
If you are a smoker, please refrain from smoking during this time period.
Provide your clinician with a list of your medical history, particularly for allergies.
You may need to undergo other medical examinations prior to the surgery. Some examples of the tests include:

ECG (electrocardiogram)
Blood tests
Chest X-ray
Urine sample

Slipping Rib Syndrome - Post-surgery care

Patients who have undergone a surgery for slipping rib syndrome may be warded for a day or as long as they are needed for observation. An electrocardiogram (ECG) monitor will continuously record the rhythm of the heart.

Physical therapy will slowly be introduced, to strengthen the patient with light physical activities.

Patients who have duly rested and have stable conditions will be arranged for discharge

Follow-up appointments for regular check-ups will also be arranged at NHCS.