Slipping rib syndrome can cause sharp rib, chest wall, upper abdominal, flank, or back pain with clicking, popping, slipping, or catching sensations.
Chest or upper abdominal pain isn't always caused by the heart or stomach. Dr. Siefferman explains slipping rib syndrome, how it's diagnosed, and the treatment options available to help relieve pain.
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Hi, I’m Dr. Jason Siefferman, medical director at Manhattan Pain Medicine. With hypermobility spectrum disorders and Ehlers-Danlos syndrome, slipping rib is not an uncommon issue. What this means is that the ribs, because the connective tissue holding them in place is stretchy, tend to slide around, and the slipping rib can affect the rib in a few different locations.
It can affect the rib at the level of the spine in the back where the rib actually joins the thoracic vertebrae. That joint can become displaced. The rib can rotate in position. It can move around because it’s not a solid joint like other joints are. It’s very much dependent on the connective tissue to hold it in place. And it’s also dependent on the intercostal muscles between the ribs to hold it in place. So that is a common area where, especially if there is some scoliosis, if there is some increased kyphosis of the thoracic spine, it’ll put pressure on those ribs and cause them to twist.
The other thing that will happen is if there’s any abdominal strain, pain, hernias, anything that causes increased abdominal muscle activity, that will also pull on the ribs and can have a downward effect. In addition to the rib at the back having some rotation or pull and causing pain at that site, the ribs can also rub against each other. This happens usually along the lower ribs, and between the ribs there’s an intercostal nerve which can get pinched, and that can become irritated, or the bone itself can actually rub and then the periosteum, or the skin of the bone, will actually develop a callus which can become supersensitized. That’s a more tricky situation to treat.
Again, generally we want to try to stabilize the ribs. We do this with regenerative medicine; we use physical therapy. Often that’s successful and then, if it’s not, of course there are always surgical options, but we try to avoid those if possible. Of course it’s a last resort, but it’s an option if needed.
Finally, the last place the slipping rib affects is where the rib actually comes to the chondral junction in the front. So there’s softer cartilage which connects the tips of most of the ribs, usually not the 12th rib, where the rib attaches to that cartilage can also stretch, move—there can be motion at that insertion point. And that’s another place where there can be pain, and that’s also amenable to treatment with regenerative medicine.
Slipping rib syndrome is an underrecognized musculoskeletal condition that can cause sharp, intermittent pain in the lower ribs, chest wall, upper abdomen, flank, or back. It may occur when lower rib cartilage becomes loose or unstable, allowing a rib to move abnormally and irritate an intercostal nerve.
Patients may feel clicking, popping, slipping, catching, or pain triggered by twisting, coughing, bending, deep breathing, or certain positions.
Because slipping rib syndrome may not appear on standard X-rays, CT scans, or MRIs, diagnosis often requires careful history, physical examination, and dynamic assessment when appropriate.
At Manhattan Pain Medicine (MPM), evaluation begins by identifying whether rib instability is truly driving the pain or whether symptoms are coming from another source.
For patients looking for slipping rib syndrome treatment in Manhattan, MPM evaluates rib motion, lower chest wall pain, upper abdominal pain, thoracic referral, intercostal nerve irritation, abdominal wall pain, hypermobility, EDS, and chronic musculoskeletal pain patterns.
Care may include diagnostic ultrasound, dynamic ultrasound assessment when appropriate, ultrasound-guided injections, nerve-targeted care, prolotherapy, PRP, BMAC, regenerative medicine discussions, or surgical referral when instability requires additional evaluation.
Slipping rib syndrome can be difficult to diagnose because the pain may mimic several other conditions. Patients may be evaluated for gastrointestinal, gallbladder, kidney, cardiac, lung, spine, abdominal wall, or musculoskeletal causes before rib instability is considered. Standard imaging may look normal because the problem often appears during movement, not when the body is still.
This is why MPM uses a diagnosis-first approach. The evaluation asks whether the pain is related to rib motion, costal cartilage instability, intercostal nerve irritation, thoracic spine referral, abdominal wall pain, hypermobility, EDS, or another pain generator. A clicking sensation alone is not enough to confirm the diagnosis. The goal is to reproduce the familiar pain pattern safely and determine whether slipping rib syndrome fits the full clinical picture.
Slipping rib syndrome fits within MPM’s Musculoskeletal issues Zone of Expertise, with important overlap in Hypermobility when EDS, hypermobility spectrum disorder, connective tissue laxity, recurrent subluxation, or instability is present. This matters because rib pain may come from rib motion, cartilage laxity, intercostal nerve irritation, muscle guarding, thoracic spine mechanics, or a combination.
MPM uses the Zones of Expertise framework to determine whether symptoms are rib-based, nerve-related, hypermobility-related, thoracic, abdominal wall-related, or part of a broader chronic pain pattern. This helps guide whether the next step should be dynamic ultrasound, ultrasound-guided injection, nerve-targeted treatment, prolotherapy discussion, regenerative care discussion, rehabilitation coordination, or surgical referral.
These guys are the best. I've been going here for over 6 years and their familiarity with my Schwannomatosis (most ppl have never even heard of it - its rather rare) and their ability to diagnose my CRPS quickly and accurately and then treat it like I was merely getting a flu shot is just incredible...
Highly recommended for those who need Pain Management. Everyone at Manhattan Pain Medicine is extremely nice and helpful. I have had very good interactions with both Dr. Siefferman and Dr. Louis. All of the staff is very responsive. 5 stars.
The providers at Manhattan Pain Medicine are exceptional. I wish I had found them 30 years ago!
I genuinely can’t say enough good things about the team at Manhattan Pain Medicine. I have MCAS, EDS, and an inflammatory autoimmune disease, and I’ve basically been searching for answers since I was a kid. I had years of unexplained inflammation markers, chronic pain, and allergic reactions despite...
I have a complex medical history and have seen a lot of doctors over the years. Dr. Mikaberidze and Dr. Siefferman each took the time to really listen and understand everything I had been dealing with. I also appreciated how they work together and communicated about my care. I left with a plan that...
Sharing my gratitude for the pleasant experience last week during my visit, the medical team provided great care and also treated my session as a learning experience, I left my session with a wealth of knowledge. A big thank you to the kind, and professional staff who welcomed me to the office as a...
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
Dr Siefferman is the most thorough, patient doctor I have even been to. Currently I travel from miami to nyc to see him because his bed side manner and desire to help is incomparable.
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This practice is wonderful. I have been a patient of Dr. Siefferman’s since 2019 and he’s extremely helpful and kind. He has brought in a Rheumatologist who is also great. They handle very complex pain issues and always try to find new ways to help me.
Dr. Siefferman is an incredible doctor! He is extremely diligent and knowledgeable. It feels like you are his only patient. He invests a lot of time and effort into your injuries and concerns. I did not find these wonderful qualities with other pain specialists before, who were always rushed and som...
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Dr. Siefferman is a doctor who combines the old world bedside manner of doctors from my childhood (60 years ago) with a sta te of the art embrace of modern technology. It is always a pleasure to have an appointment with him...always has options and solutions to my medical issues. He is truly the doc...
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Dr. Siefferman is a genius. He is very informed and listens attentively.
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Dr. Siefferman and his entire team continue to be efficient, dedicated, and driven by precision and a genuine desire to give fantastic care. Will always recommend.
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Doctor Siefferman is fantastic. Have been seeing him for 5 years. Couldn’t recommend more.
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Dr. Siefferman is the ONLY doctor who has ever been able to diagnose my pain and treat it. He is hands down the best
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Slipping rib syndrome is a musculoskeletal condition in which one or more lower ribs move abnormally because of loose or unstable cartilage. This movement may irritate an intercostal nerve and cause sharp, movement-related pain. Symptoms often involve the lower ribs, chest wall, upper abdomen, flank, or back. Some patients feel clicking, popping, slipping, or catching. Slipping rib syndrome can be difficult to recognize because it may mimic gastrointestinal, chest, spine, or abdominal wall pain, and standard imaging may appear normal.
Slipping rib syndrome may feel like sharp, stabbing, burning, or catching pain near the lower ribs, upper abdomen, flank, chest wall, or back. Pain may worsen with twisting, coughing, bending, lifting, deep breathing, reaching, or certain positions. Some patients feel a rib pop, click, move, or slip. Others do not feel obvious movement but have reproducible pain in the same rib area. Symptoms may come and go, which can make diagnosis more difficult. Evaluation should confirm whether rib instability fits the full pain pattern.
Slipping rib syndrome is often missed because symptoms can look like other problems, including GI pain, gallbladder pain, kidney pain, thoracic spine pain, abdominal wall pain, chest wall pain, intercostal nerve pain, or muscle strain. Standard X-rays, CT scans, or MRIs may not show the rib slipping because the abnormal motion may occur only during movement. Many patients have normal testing before slipping rib syndrome is considered. A careful exam and, in selected cases, dynamic ultrasound can help evaluate whether rib movement reproduces the patient’s familiar pain.
Slipping rib syndrome is evaluated through medical history, physical examination, symptom reproduction, rib and chest wall assessment, and careful exclusion of urgent or non-musculoskeletal causes. Some clinicians may use a hooking maneuver or other provocative maneuvers when appropriate. Diagnostic ultrasound or dynamic ultrasound may help assess rib motion during movement. In selected cases, diagnostic injections or nerve blocks may help clarify whether rib movement or intercostal nerve irritation is contributing. A clicking rib alone is not enough to confirm the diagnosis.
Yes. Ehlers-Danlos syndrome and hypermobility spectrum disorder may contribute to slipping rib syndrome in some patients because connective tissue laxity can affect rib and cartilage stability. Patients with hypermobility may be more prone to subluxation, instability, muscle guarding, and recurrent musculoskeletal pain. When rib cartilage is more mobile, rib movement may irritate nearby nerves or soft tissues. MPM evaluates slipping rib symptoms in the context of hypermobility, EDS, thoracic mechanics, rib motion, and chronic pain sensitivity.
Yes. Slipping rib syndrome can cause pain that feels like upper abdominal pain, flank pain, back pain, or chest wall pain. This may happen because abnormal rib motion can irritate intercostal nerves, and those nerves can refer pain around the rib cage and abdominal wall. This overlap is one reason patients may undergo GI, abdominal, spine, or chest evaluations before rib instability is considered. MPM evaluates whether the pain pattern is rib-related, abdominal wall-related, thoracic spine-related, nerve-related, or coming from another source.
Treatment depends on the cause and severity of symptoms. Options may include activity modification, targeted rehabilitation, movement and breathing mechanics, diagnostic ultrasound, dynamic ultrasound assessment, ultrasound-guided injections, intercostal nerve blocks, prolotherapy, or regenerative medicine discussions in selected cases. If rib instability is severe or symptoms persist despite appropriate nonsurgical care, surgical referral may be considered. Treatment should be individualized and based on anatomy, symptom reproduction, prior workup, hypermobility status, risks, and goals.
PRP, BMAC, and prolotherapy may be discussed only in selected cases after diagnosis, anatomy, instability pattern, risks, goals, and evidence are reviewed. These treatments should not be described as guaranteed rib stabilization, cartilage repair, surgery prevention, or permanent relief. Prolotherapy may be considered in some instability-related musculoskeletal pain patterns, but it is not appropriate for every patient. MPM uses regenerative discussions carefully and only when the suspected pain generator and treatment goal are clear.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
Slipping rib syndrome is an underrecognized cause of lower rib, chest wall, upper abdominal, flank, or back pain. It may occur when the cartilage that helps support the lower ribs becomes loose or unstable. When the rib moves abnormally, it can irritate an intercostal nerve and cause sharp, catching, burning, or stabbing pain.
Patients may feel a clicking, popping, slipping, or catching sensation. Pain may worsen with twisting, coughing, bending, deep breathing, lifting, reaching, rolling in bed, or certain positions. Some patients can reproduce the pain with specific movements. Others have intermittent symptoms that make the condition difficult to identify.
Slipping rib syndrome can mimic several other conditions. Pain may feel like gastrointestinal pain, gallbladder pain, kidney pain, abdominal wall pain, thoracic spine pain, rib fracture, intercostal neuralgia, or chest wall inflammation. Because symptoms can occur near the upper abdomen or chest wall, patients may have extensive workups before rib instability is considered.
Standard imaging may not show the issue because the rib may appear normal when the patient is still. X-rays, CT scans, and MRIs are often static. Slipping rib syndrome may become visible only when the rib moves during a provoking maneuver. This is why dynamic assessment can be important in selected patients.
Hypermobility can make rib pain more complex. Patients with Ehlers-Danlos syndrome or hypermobility spectrum disorder may have connective tissue laxity that affects joint and cartilage stability. In some patients, this may contribute to rib subluxation, rib-tip pain, chest wall discomfort, muscle guarding, or intercostal nerve irritation.
When hypermobility is present, treatment should not focus only on the painful rib. The evaluation should consider rib mechanics, breathing patterns, thoracic spine movement, abdominal wall tension, connective tissue laxity, muscle compensation, and chronic pain sensitivity. Patients with hypermobility may also need a more careful and gradual approach to rehabilitation and load management.
MPM begins with a detailed history and physical examination. The clinician reviews where pain occurs, how it feels, what movements provoke it, whether there is clicking or slipping, what imaging has been done, and whether symptoms overlap with abdominal, thoracic, or nerve-related pain.
The exam may assess rib tenderness, rib motion, thoracic mechanics, abdominal wall sensitivity, nerve-related symptoms, and pain reproduction. In selected cases, dynamic ultrasound may be used to assess whether rib movement occurs during maneuvers that reproduce the patient’s familiar pain. Diagnostic blocks or ultrasound-guided injections may be considered when the clinical picture supports intercostal nerve irritation or a specific rib-related pain generator.
Dynamic ultrasound can be useful because slipping rib syndrome is a movement-related condition. The clinician may assess rib motion while the patient performs movements that typically provoke symptoms, such as twisting, bending, coughing, or abdominal contraction. If abnormal rib movement is seen and the patient’s familiar pain is reproduced, this can support the diagnosis.
Dynamic ultrasound is not the only part of the diagnosis. It should be interpreted alongside history, physical examination, red-flag screening, and prior medical evaluation. Rib pain should not be assumed to be slipping rib syndrome until serious cardiac, pulmonary, GI, vascular, infectious, traumatic, or abdominal causes have been considered when appropriate.
Treatment depends on severity, anatomy, instability, pain generator, and patient goals. Some patients benefit from activity modification, targeted physical therapy, movement retraining, breathing mechanics, and strategies to reduce provocative rib motion. If intercostal nerve irritation is suspected, ultrasound-guided injections or nerve blocks may be considered in selected cases.
Prolotherapy may be discussed when symptoms suggest ligamentous or cartilage-related instability and the patient is an appropriate candidate. PRP, BMAC, or regenerative medicine may be considered only after careful review of diagnosis, anatomy, risk, and evidence. These treatments should not be presented as guaranteed rib stabilization or cartilage repair.
Some patients with significant rib instability or persistent symptoms may require surgical evaluation. Surgery may be considered when slipping rib syndrome is well supported by the clinical picture and nonsurgical care has not been sufficient. MPM may coordinate referral when symptoms, instability, or functional limitation suggest that surgical assessment is appropriate.
Rib, chest, or upper abdominal pain should be evaluated carefully because symptoms can overlap with heart, lung, GI, gallbladder, kidney, vascular, infection, fracture, spine, nerve, and abdominal wall conditions. Patients should seek urgent care for chest pressure, shortness of breath, fainting, fever, coughing blood, severe trauma, severe abdominal pain, unexplained weight loss, new neurologic symptoms, or rapidly worsening pain.
MPM approaches slipping rib syndrome through a diagnosis-first, function-focused model. The evaluation considers rib instability, costal cartilage laxity, intercostal nerve irritation, hypermobility, EDS, abdominal wall pain, thoracic spine referral, muscle guarding, and chronic musculoskeletal pain contributors.
For patients looking for slipping rib syndrome treatment in Manhattan, MPM offers a careful pain medicine perspective that can work alongside physical therapy, surgery, orthopedics, and other specialists when needed. The goal is to validate real movement-related rib pain, identify the correct pain generator, and build a treatment plan that fits the patient’s anatomy, instability pattern, risks, and goals.
