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Slipping Rib Syndrome

Slipping rib syndrome (SRS) is a condition that mainly affects the lower costal cartilages of the false ribs, 8-10. When these ribs do not have intact attachments forming a costal margin, they are able to slip under or over one another, potentially impinging the intercostal nerve, causing pain.  It is reported in any age group and is more prevalent in young athletic females.  Likely many people have a costal margin that is not intact, but a small subset of these experience pain.  The pain can be associated with popping or clicking and can be induced by certain movements such as sneezing, twisting, bending or exercise.  The pain can be sharp and short-lived, followed by hours of dull achy pain.  Some people experience this sporadically but for others the pain can be constant and debilitating. (1,2)


After eliciting a history that is suspicious for SRS, the physical exam involves palpating the area of pain.  The traditional method of eliciting a slipping rib is via the hook maneuver, in which the lower costal margin is grasped and pulled upward, to feel movement of the cartilage.  (3) This is exquisitely painful for a patient suffering from SRS.  Another method is to gently palpate the costal margin and feel the movement of the ribs under the fingers.  A slipping rib will easily move away from the other cartilages and one can feel the abnormal contour of the costal margin.

Static imaging does not demonstrate SRS.  Dynamic ultrasound is a modality in which the patient either moves or the sonographer pushes on the ribcage while watching the costal margin.  This had good efficacy. (4)

Rib blocks, while sometimes therapeutic, can also demonstrate the level of the pain – when a block is performed, the rib that is affected is identified. 

Figure 1 False Ribs 8-10 are not connected in a costal margin in SRS
Figure 2 resected 9th slipping rib cartilage

Figure 3 Vertical rib plating ribs 7-10 after resecting slipping rib cartilages


Lisa McMahon, M.D.


Foley et al. Clin J Sport Med. 2019

McMahon. Pediatr Surg. 2018

Heinz et al. J Am Med Assoc . 1977

Van Tassel et al. Skeletal Radiol. 2019

McMahon et al. J Pediatr Surg. 2021

Hansen et al. Ann Thorac Surg. 2020

Gould et al. J Ped Surg. 2016

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