Slipping Rib Syndrome

Slipping rib syndrome is intermittent lower chest wall or upper abdominal pain caused by a hypermobile false rib tip (ribs 8 to 10) slipping against the rib above and irritating the intercostal nerve.

It is also called Cyriax syndrome or clicking rib. It is often overlooked and misdiagnosed as costochondritis, intercostal strain, gallbladder disease, irritable bowel syndrome or cardiac pain, so patients commonly see several clinicians and have many tests before diagnosis. Make the diagnosis confidently only once cardiac, pulmonary and abdominal causes have been considered.

Ribs 1 to 7 join the sternum through their own costal cartilages. The false ribs, 8 to 10, do not: each cartilage curves up to the cartilage above through interchondral attachments, so their anterior stability depends on these connections. Ribs 11 and 12 float. Painful 12th rib syndrome, with flank or groin radiation, is a related but separate condition.

When an interchondral attachment weakens, stretches or tears, the rib tip becomes hypermobile. With trunk movement it slips over or under the rib above, irritating the intercostal nerve and causing sharp pain, and the click is the tip moving across its neighbour.

• •The 10th rib is the most commonly affected; the 8th and 9th can be involved, and symptoms can be bilateral
• •Trauma is thought to be the commonest cause, direct (a blow) or indirect (forceful movement), and indirect trauma is the more common
• •Other contributors: repetitive rotational sport, generalised joint hypermobility, previous surgery, or no clear cause
• •It is more common in women, and most patients are under 40