Slipped Rib Syndrome
Diagnosis & Repair, London

• →Sharp, catching pain at the costal arch — the lower edge of the ribcage
• →Pain that spreads to the side and round to the back, near the shoulder blade
• →A clicking, popping or slipping sensation as the rib catches
• →Burning, stabbing or electrical pain — sometimes sharp enough to catch your breath
• →Little relief from ordinary painkillers — paracetamol, co-codamol, anti-inflammatories — because the pain is neuropathic
• →Investigated for gallstones or other abdominal problems, with normal ultrasound, CT or MRI
• →Symptoms for months or years without a clear diagnosis

Diagnosis rests on your symptoms and a careful, gentle examination. Dr Okiror locates the most tender point and feels for the abnormal movement while you breathe in and out — the slip is often palpable — rather than relying on the older ‘hooking’ manoeuvre, which can be unnecessarily uncomfortable. Above all, the diagnosis is confirmed with a moving (dynamic) ultrasound scan: because the problem only appears when the rib moves, a dynamic scan can show the slip in real time when ordinary scans cannot.

Standard X-ray, CT and MRI — including any abdominal scans done to look for gallstones — are usually normal in slipped rib syndrome. They remain useful, not to diagnose the slip but to rule out other causes. Dr Okiror reviews your scans personally and explains clearly what is, and is not, behind your symptoms.

In some cases a small injection of plain local anaesthetic (levobupivacaine) is used to confirm the diagnosis. If it settles the pain, a repair is very likely to help. It is a low-risk step that is especially useful for people who have had rib surgery before, or where the ultrasound is not clear-cut — a way to be confident before any operation is considered.

Non-surgical measures are always considered first — reassurance once the diagnosis is clear, physiotherapy, activity modification, and in some cases local anaesthetic injections. Where these give lasting relief, surgery is not needed. Surgery is reserved for persistent or genuinely debilitating symptoms.

For many years the only operation was to cut away and remove the slipped rib tip. The approach has moved on. Where surgery is the right step, Dr Okiror's usual operation repairs and stabilises the rib rather than removing it. Through a small incision — around 3–4 cm, placed directly over the most mobile part of the costal arch, with the examination repeated under anaesthetic to confirm the moving segment — the rib is secured back to the margin, the space between the ribs is preserved, and pressure is taken off the irritated nerve. Because the pain is neuropathic, protecting and decompressing that nerve matters more than simply removing bone. This nerve-preserving repair was developed in the United States and is now used internationally.

More complex cases — several ribs involved, hypermobility, or ribs that have been operated on before — may need reconstruction of the lower rib margin to give a durable, stable result. Most patients are in hospital for one to two days, with a return to light activities over the following one to two weeks.

Pain that continues or returns after a previous rib operation — including after a rib has been removed, or where plates or other metalwork are now causing trouble — is worth reassessing rather than accepting. Where appropriate, the rib margin can be reconstructed to stabilise the area and relieve the nerve; sometimes the better course is to remove problematic metalwork rather than add to it. Bring your previous scans and operation notes — a dedicated review of slipped rib surgery that hasn’t worked is the place to start.