Slipping rib syndrome
Doctors recognize that slipping rib syndrome is often unrecognized at the time of patient diagnosis and therefore an overlooked cause of chronic pain in the the abdominal and/or chest pain area.
Doctors also recognize that misdiagnosis or simply missing slipping rib syndrome as the cause of pain, the misdiagnosis may lead to an excessive imaging, laboratory, and other complicated workups.
- Slipping rib syndrome, which is also diagnosed as Tietze’s Syndrome, occurs when one of the ribs intermittently slips out of place, causing a stretching of the ligaments that support the front and back of the rib.
- The tenth rib is usually the culprit because, unlike ribs one through seven, which attach to the sternum, the eighth, ninth and tenth ribs are attached to each other by loose, fibrous tissue. Although this arrangement provides increased mobility of the lower rib cage, it also results in a greater susceptibility to trauma in this area.
Much of the research surrounds the pediatric and young athelete treatment of slipping rib syndrome as this uncommon disorder is more common in those two groups. However, adults can also acquire slipping rib syndrome with an forcible activity to the rib area including simple coughing to chest surgery for an unrelated cause.
In many cases a rib slips out of place because the ligaments that hold the ribs to the sternum, the sternocostal ligaments, are weakened by wear and tear or acute injury.
Surgical options and non-surgical options
Surgery to remove a piece of a rib or the costal cartilage, the unique cartilage found only at the ends of the ribs may be recommended if either structure is protruding. Even surgeons consider these options “aggressive.”1
Non-surgical treatments may include recommendations for chiropractic manipulation, cortisone or nerve block. Typically these treatments have not found great success.
Prolotherapy for Slipping Rib Syndrome and rib attachments
In our opinion surgery or masking of symptoms does not provide the athlete or the young or older patient that is possible with Prolotherapy.
Prolotherapy is an injection technique that stimulates ligament and cartilage repair. Prolotherapy will strengthen the weakened ligament junctions that can cause slipping rib syndrome – the sternocostal, the costochondral or the costovertebral junctions (the places the ribs meet to form the rib cage). It will also strengthen the costal cartilage.
1 González Temprano N, Ayuso González L, Hernández Martín S, Molina Caballero AY, Pisón Chacón J, Martínez Bermejo MA. Slipping rib syndrome. An aggressive but effective treatment. An Sist Sanit Navar. 2015 May-Aug;38(2):329-32.