Symptoms of Slipping Rib Syndrome
Slipping rib syndrome presents with sharp, intermittent lower chest or upper abdominal pain that is reproduced by specific movements and the hooking maneuver, caused by hypermobility of ribs 8-10 that sublux and impinge on intercostal nerves. 1, 2
Primary Pain Characteristics
- Sharp, intermittent pain located in the lower chest wall and subcostal region, typically unilateral but can be bilateral 2
- Pain is waxing and waning in nature, not constant 2
- Non-radiating pain that stays localized to the affected rib area 2
- Pain is aggravated by specific movements, including upper-extremity activities, coughing, laughing, or leaning over 3
- The pain can be debilitating and significantly impact daily activities 4
Physical Examination Findings
- Positive hooking maneuver is the hallmark diagnostic finding—pulling the anterior rib margin forward reproduces the characteristic pain and may produce an audible click 2, 3
- Point tenderness at the affected costal margin where the rib subluxes 5
- Patients may demonstrate the slipping or clicking sensation of the rib moving under the adjacent rib 6
- Palpable hypermobility of the anterior false ribs (ribs 8-10) on examination 1, 6
Associated Symptoms
- Clicking or popping sensation in the lower chest wall with movement 6
- Pain that worsens with certain postures or positions 2
- Symptoms may be present for months to years before diagnosis, as this condition is frequently underdiagnosed 6
- The pain is often refractory to standard analgesics and muscle relaxants 2
Common Pitfalls in Recognition
The diagnosis is frequently missed because patients undergo extensive unnecessary testing (CT scans, MRIs, X-rays) that fail to show abnormalities, leading to years of undiagnosed pain 2. The condition is primarily clinical, and dynamic ultrasound has emerged as the most useful diagnostic tool, detecting slipping rib syndrome in 89% of cases 1. Standard static imaging is typically normal and should not be relied upon to exclude this diagnosis 2.