True ribs (1-7th)
Directly attached to the sternum, their costal cartilages are connected by the sternocostal joints.
False ribs ( 8-9th or 10th)
Indirectly attached to the sternum, their costal cartilages connect with the seventh costal cartilage by the costochondral joint.
-The 8th to 10th ribs have been described as each having cartilaginous attachments to the rib above it. These interchondral joints fuse to form the costal margin and costal arch, which attach to the lower sternum.
-The costal arch made by fused costal cartilages of 7th, 8th, 9th, and usually also 10th.
Floating ribs (10th-11th or 11th-12th)
Do not attach to the sternum. They are the distal two ribs.
Slipped rib syndrome (“slipping rib syndrome”) is the constellation of symptoms resulting from the impingement of intercostal nerves between slipping rib tips.
Due to various factors, such as trauma or degeneration, disruption of the interchondral attachments between ribs can result in weakness and rib separation at the costal margin.
This results in hypermobility and subluxation of the rib; the tip of the hypermobile rib can impinge on the intercostal nerve of the rib above, causing a complex pain response with activity and movement, leading to limitations in quality of life.
Intercostal nerves are highly sensitive and prone to producing chronic pain when injured. It may generate severe pain in a dermatomal distribution in the affected intercostal space, originating anteriorly and radiating back to the spine. Such intercostal neuralgia is the predominant symptom observed in SRS.
To diagnose slipping rib syndrome, an examination must be conducted by medical providers who possess knowledge and training in this rare debilitating syndrome.
In many cases, radiologic imaging of the chest and abdomen, such as chest X-rays, MRIs, and regular CT scans, do not reveal any abnormalities. While costal cartilage may not be visible in regular CT scans, 3D CT or High-Resolution scans can uncover protruding ribs and costal cartilage. High-resolution ultrasound (Dynamic ultrasound) can confirm the ribs' movement and compression of muscles, tendons, and intercostal nerves.
Although Slipping Rib Syndrome was identified by a British orthopedic surgeon in 1919, it remains a relatively obscure condition in the medical field.
The latest publication (2023), “A Review of Slipping Rib Syndrome: Diagnostic and Treatment Updates to a Rare and Challenging Problem.” shows SRS is a poorly understood diagnosis resulting in significantly delayed and unnecessary diagnostic tests. Early and accurate diagnosis coupled with timely referral to a surgical provider with expertise in SRS is the most important aspect of treatment.
The study also shows that delay in diagnosis and treatment has a profound effect on patients’ mental health. One-third of patients in an adult SRS cohort had suicidal ideations due to pain; three patients had attempted suicide. Other studies have shown an increased likelihood of SRS patients linked with a psychiatric diagnosis, including depression. This may be linked with ongoing chronic pain, as well as the overall strain between the patient and provider, given the delay in diagnosis of slipped rib syndrome in these patients.
Studies estimate that Slipping Rib Syndrome accounts for approximately 5% of all musculoskeletal pain in primary care. Slipping rib syndrome may be more common than previously documented.
”12th rib syndrome” is Involved in the floating ribs (11th–12th), a hypermobility of the 11th-12th ribs irritating the surrounding tissues and nervous systems.
Iliocostalis syndrome is a condition caused by friction of the lower ribs against the iliac crest, which leads to irritation of soft tissues. It is characterized by undiagnosed chronic side pain. Also known as iliocostal friction syndrome, iliocostalis syndrome occurs most often among individuals suffering from osteoporosis.
Clicking rib syndrome
Costal cartilage detachments
Costal cartilage fractures
Costal margin detachments
Costal margin fractures
Painful rib syndrome
Rib cartilage syndrome
Rib tip syndrome
Slipped rib syndrome
Pleuritic chest pain,
Various heart conditions
Included Slipping Rib Syndrome along with Chest Wall Injuries.
Feb 8, 2024 Advance with MUSC Health
MUSC Health is a leader in treating chest wall injuries, including rib fracture care. People come to the MUSC Chest Wall Injury and Reconstruction Center from all over the Southeast and beyond for innovative treatments after traumatic accidents, falls and other cases involving rib and chest wall injuries. Dr. Evert Eriksson is a general surgeon who specializes in injuries to the chest wall. He explains what sets MUSC apart in this area and the hope he offers to so many patients.
Jan 28, 2022
Dr. Joseph Forrester presents "Surgical Management of Chest Wall Injury" at Department Grand Rounds on Tuesday, January 25, 2022.
Talks about Anatomy of the Chest Wall, Chest wall Injuries, Slipping Rib Syndrome, a number of other important muscles that contribute to the structure of the chest wall as well as treatment options.
Mar 4, 2021
Dr. Lisa McMahon, co-director of the Phoenix Children's chest wall program
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