Rib subluxation : Identify and Treat Slipping Rib Syndrome

a young man with rib subluxation

Rib cage is the bony structure that protects our internal organs in chest region. Lungs, heart, aorta, oesophagus and main other important structures are included in thoracic area which are protected by rib cage. Rib cage is a moveable structure which moves with breathing and moving.

What is rib subluxation ?

Rib subluxation is misalignment of the ribs. Basically when we breath or move our ribs adjust accordingly and once the movements are over, it returns to the original position. If this won’t happens that means ribs are subluxed. It would be very painful condition that won’t allow a person to change their posture.

Basic anatomy of the rib cage

There are 12 pairs of ribs. According to there anatomical landmarks they are categorized as 1st to 7th rib pairs as “true ribs”, 8th to 10th pairs as “false ribs” and 11th and 12th ones are as “floating ribs”. All these 12 pairs are attached to the spines with their two attachment sites. Only true ribs are attached to sternum or breast bone with own pairs of cartilages. False ribs are attached with single pair of cartilage and floating ribs have no attachment from front. That’s why they are called as floating ribs.

In-between each ribs there are intercostal muscles which facilitate movements of the rib cage. The nerves and blood vessels supplying to the thoracic area traverse through the lower border of each rib.

Rib cage anatomy to identify rib subluxation
Rib cage anatomy

How does the rib subluxation occur ?

Rib subluxation is most commonly seen in 8th to 10th ribs which are false ribs because of there relatively weak attachment. A sudden force leading to strong contraction of the intercostal muscles or movements with a wrong position or trauma are the causes for this.

This condition is common with,

  • Contact sports like rugby, american football, ice hockey which can cause direct trauma.
  • Falling from height and impact on chest.
  • Sudden throwing of a object or swimming which cause extreme stretching of the arm.
  • Even there are instances that repetitive, vigorous coughing and sneezing resulting rib subluxation.

The connection between rib subluxation and Ehlers-Danlos Syndrome ( EDS )

EDS patients are more common to have rib subluxation because certain characteristics of their disease.

  • They are commonly have scoliosis, a spinal deformity which gives a structural disadvantage.
  • Their spines are less stable and joints are highly lax. Therefore rib attachments are easily get misaligned.
  • Their joint position sensation is low, therefore they are more prone to get uncoordinated movements.

What are the symptoms of rib subluxation ?

The main complain is sudden intense sharp pain over the chest wall after a above mentioned incident. The pain get severe with move like deep breathing, coughing, laughing and etc. Sometimes the pain can radiate to the back, neck and even along with arm also. Therefore in some cases people are mistaken this as a much severe “heart attack”.

The reason for the pain is once rib get misaligned the nerves going on lower border of the rib get stretched and even in some cases get compressed by near bony structures. Therefore this sharp pain occurs.

There can be seen a bulging over the site, which is mobile but it’s not a common symptom. Swelling can be noticed at the site with reddish appearance.

A person can feel slipping or popping sensation over the site. And the site is very tender to touch.

How severe is this condition ?

Rib subluxation is not a fatal condition. The pain is the main problem that cause even a person to become bedridden. Because even a slight movement like breathing also can be very painful.

How to diagnose the condition ?

This is a clinical diagnosis mainly your doctor would do with the acute symptoms and the causative incidents. But the definitive diagnosis will give after performing a chest X-ray to exclude the other possibilities.

Definitive diagnosis of Rib subluxation
Definitive diagnosis of Rib subluxation

What are the treatments for rib subluxation ?

There are both medical and surgical treatments for this condition. All of those treatment strategies targeting reducing the pain.

  • Resting and restricting the movements can be done as a basic task.
  • Applying heat would be a good option to relax the muscles and reduce the muscle spasms around the area. So nerve compression may get released.
  • The doctor can the ask the person to wear a chest binder to stabilise the ribs.

As a medical management using painkillers is a good choice. Ibuprofen, Naproxen are the commonly used drugs for pain relief. It’s better to use this drugs with a proper medical advice. Because having heart diseases, kidney diseases, liver diseases and bleeding problems can cause severe side effects with this medications.

Intercostal nerve blocks also can be used with an anaesthetic drug. It would be hospital based procedure which need to be done with an extra caution. Because the procedure has a possibility of damage the external coverings of the lungs which is called pleural and results pneumothorax which is accumulation of air in the chest cavity.

Chiropractic therapy is also an optional method. It can readjust the misaligned rib and reduce the pain also. It proceeds with proper pain relief methods and some times ultrasound guidance may be necessary.

As the surgical option the cartilage can be removed which is called costal cartilage excision.

When you should contact the doctor ?

If you have following symptoms it’s better to consult the doctor. Because it need to investigate thoroughly as there can be a different issue.

  • If the symptoms occur even in daily activities
  • Develop shortness of breath
  • The incidence associated with chest trauma.

Sources :

  1. E.A.K. van Delft,K.M. van Pul,F.W. Bloemers.(2013). Slipping rib syndrome- case report
  2. Copeland G.P., Macin D.G., Shennan J.M.(1984).Surgical treatment of the ‘slipping rib syndrome’
  3. ucsfhealth.org. Slipping rib syndrome
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Dr. Sapumal Edirisinghe

MEDICAL DOCTOR (mbbS)

I am a medical doctor who is passionate about the new medical knowledge and spread those to the world to make the world a better place.

Sapumal Edirisinghe

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