A frequently misdiagnosed cause of lower chest and upper abdominal pain. Specialist assessment using the hooking manoeuvre. Highly effective keyhole rib resection where surgery is indicated. London Bridge Hospital and Lister Hospital Chelsea. Unexplained chest pain page →
Last reviewed: April 2026 · Dr Lawrence Okiror FRCS(CTh) FRCSEd(CTh) · GMC 6150382
Slipped rib syndrome — lower ribs (8th, 9th, 10th) loosen from their fibrocartilaginous attachments, causing catching, clicking pain in the lower chest
The hooking manoeuvre at bedside — hooking fingers under the rib margin and pulling anteriorly reproduces the characteristic pain and clicking. Often normal on all imaging
Keyhole rib resection — removal of the unstable rib tip. Pain relief achieved in over 80% of patients. Typically one to two days in hospital
Slipped rib syndrome — also known as clicking rib syndrome, rib-tip syndrome, or costal cartilage syndrome — is a condition in which one or more of the lower ribs (most commonly the 8th, 9th, or 10th rib) move abnormally, catching on adjacent ribs or intercostal structures and causing significant pain.
Unlike the upper ribs, the lower ribs are not directly attached to the sternum. Instead, they are joined to one another by fibrocartilaginous tissue. When this tissue weakens or loosens — through injury, repetitive strain, or simply over time — the affected rib can slip and move in a way that causes a distinctive clicking sensation and sharp, often debilitating pain.
Pain is typically felt in the lower chest or upper abdomen, frequently radiates to the back between the shoulder blades, and is worsened by twisting movements, reaching overhead, taking a deep breath, or even prolonged sitting.
The hooking manoeuvre — hooking a finger under the rib margin and gently pulling anteriorly to reproduce the familiar pain and clicking — is the key diagnostic test for slipped rib syndrome. It can be performed at the bedside, without any imaging or blood tests.
This simple test is not widely known outside of specialist thoracic practice, which explains why slipped rib syndrome is so often missed or misattributed to other causes. Dr Okiror has extensive experience with this technique and diagnoses the condition promptly at the first consultation.
Non-surgical options are always discussed first. These include local anaesthetic and steroid injections and activity modification. Where these provide lasting relief, surgery is not needed. For patients with persistent or debilitating symptoms, surgery offers the best prospect of long-term improvement.
Where surgery is appropriate, minimally invasive keyhole rib resection is performed under general anaesthesia. The operation involves removing the offending rib tip through small incisions, eliminating the structural cause of the slipping and catching. Most patients are discharged one to two days after surgery. Published series report relief in over 80% of surgical patients.
Slipped rib syndrome is commonly misdiagnosed for months or years. Below are the questions patients most frequently ask. See also the unexplained chest pain page →
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Jo Mitchelson, Private PA · 020 7952 2882 · pa@lungsurgeon.co.uk
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Starting from a symptom rather than a diagnosis? The unexplained chest pain page covers thoracic causes
Thoracic Outlet SyndromeArm pain, numbness and weakness — another frequently misdiagnosed chest wall condition
Second OpinionBeen told your pain has no surgical cause? An independent assessment is always worthwhile