I have had quite a few messages since a media article came out about me. Messages from people who have slipping rib syndrome themselves, and messages from people who have the same symptoms but didn't realise what it was. I's so glad that I've managed to help so many people find out how to diagnose this condition, and ways to treat it. I have decided to compile a list of references below, to help people find out more about slipping rib syndrome. If you have any questions, please don't hesitate to contact me.
What is Slipping Rib Syndrome?
Slipping rib syndrome is when the cartilage and the ribs slip away/detach from each other (usually the false ribs - ribs 8-12). With the cartilage no longer holding the rib in place, the tip of the rib is slipping, stabbing the insides and causing pain and inflammation. There are a lot of nerves in that area which makes it a lot more painful.
Common Symptoms:
- Intense pain in the lower chest or upper abdomen around the costal margin, mostly at the height of the 8th, 9th and 10th ribs (false ribs)
- Reproduction of the pain by pressing the tender spot
- Clicking or palpable movement of the ribs
- Worsening of symptoms in certain positions, for most sitting down.
- Can also be made worse by certain postures and movements; such as lying or turning in bed, rising from a chair, driving, stretching, reaching, lifting, bending, twisting the trunk, coughing, walking, or heavy lifting.
- Can be described as a intermittent sharp stabbing pain followed by a constant monotonous pain that may last from several hours to many weeks
- Range of severity of pain varies from being a minor nuisance, moderately severe to interfering with activities of daily living
- May also radiate from the costochondral area to the chest or to the same level in the back.
Diagnosis
Slipping rib syndrome is difficult to diagnose because the symptoms resemble other conditions and it is widely unknown, so doctors don't know what to look for.
The hooking manoeuvre is painful but can help diagnose slipping rib syndrome. To perform this test hook your fingers under the rib margins and then move them upward and back. It will produce pain and sometimes a clicking sensation.
Dynamic ultrasound is a good way to diagnose it, but it doesn't usually show up in regular ultrasounds, MRI, X-ray, TC bone scan etc. It is of course good to rule other conditions out.
Treatment and Self-Help
If your condition is not severe, training the muscles around the affected area might help and even allow you to avoid surgery
Icing helps numb the pain away and reduce swelling, best for flare ups which recently started
Heat helps calm down hardened muscles and relaxes the area
Walking and light exercise (as much as possible) helps the mind and the flow of blood
If standing is better than sitting for you, Standing desks might be an option they help you avoid sitting or other positions which will cause you pain, might be tiring at first but you will get used to it
Medications
- NSAID's and/or paracetamol might help at first
- Nerve pain-killers such as Gabapentin, Nortriptyline, Amitriptyline
- CBD Oil (I haven't tried this yet, but have heard from others that it's helped)
- Opioids such as Tramadol short-term, will yield the most pain relief, at the cost of some side effects.
There are many options, not everyone is equal, make sure you consult with your doctor.
Surgery
Not recommended option: In the past, SRS would be treated by a rib resection (removing part of the rib and/or cartilage). This can work for some people, but for many people, it causes other long term issues and doesn't always work.
Recommended option: Dr Adam Hansen, who works at United Hospital Center in West Virginia, USA, has created a minimally invasive repair procedure using sutures, that stabilises the rib cage. This has changed the lives of so many people for the better. There are surgeons all over the world who are learning this procedure now.
Please see below for information and Resources about Dr. Hansen's Rib Suturing, minimally invasive repair
Extra Tips
Avoid laying down all day - move around
Avoid waiting too long to get help, any pain lasting longer than 2 months is not normal
Keep trying until you find someone who can help - Avoid staying too long in one place hoping for a solution, this condition is rare most doctors have never heard of it, even a lot of thoracic surgeons, so you will be treated by common means, meaning NSAID's and rest (this won't cut it if it's severe). You have to move on until you find someone who will listen, and you get the help you need.
Don't be ashamed or feel bad for asking about a special chair or desk at work
Do not allow this to get the best of you, there is light at the end of the tunnel. It can be emotionally draining so it's important to look after yourself emotionally, here are some tips:
- mediation
- mindfulness
- keep a gratitude journal
- focus on positive things, don't let the pain get the better of you
- speak to a therapist
Resources and Links
Main Paper by Dr Hansen: https://drive.google.com/file/d/11wyQdxHmVrrDE8KHttalS26lVpaF_3jR/view?usp=sharing
Webinar by Dr Hansen: https://www.youtube.com/watch?v=EZDFe3fC6ck&t=4s&ab_channel=AdamHansen
Here are some other links:
https://pubmed.ncbi.nlm.nih.gov/32330472/
https://www.hindawi.com/journals/crim/2018/7484560/
https://www.physio-pedia.com/Slipping_Rib_Syndrome
If you think you may have slipping rib syndrome, there is a facebook group that is a wealth of information - have a look https://www.facebook.com/groups/783005615189562
