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.
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. I have extensive experience with this technique and diagnose 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. However, for many patients with persistent or debilitating symptoms, surgery offers the best prospect of long-term improvement.
Where surgery is appropriate, I perform minimally invasive (keyhole) rib resection 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 and experience a meaningful improvement in pain. 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.
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