Slipping Rib Syndrome: What I Learned After Years of Pain, Negative Imaging, and Talking Directly With Surgeons
I’ve debated making this post for a long time, but I finally feel obligated to share this because I genuinely do not see this discussed enough anywhere online. For context, I am a U.S. MD medical student at a well-established medical school with an extensive background in orthopedic surgery and musculoskeletal anatomy. I mention this not to sound arrogant, but to provide some credibility and context behind what I’m about to say. I’ve spent years studying anatomy in depth, including the ribs, intercostal spaces, thoracic wall mechanics, and intercostal nerves. I have personally dealt with slipping rib syndrome for years. My symptoms included severe right-sided pain, audible and palpable clicking with movement, pain with twisting motions, pain with deep inspiration, and the sensation of the rib moving or catching. Like many of you, I went through the entire workup — multiple CT scans of the chest, MRIs, evaluations for gallbladder pathology, and essentially every test imaginable. Everything came back negative. I also sat down one-on-one with orthopedic surgeons reviewing my imaging and physical exams in detail, and I sat down with radiologists going through my CT and MRI scans slice by slice. Again, nothing definitive on imaging. That is part of what makes slipping rib syndrome so frustrating.
Now here is the important part of this post. In patients with Ehlers-Danlos syndrome or other connective tissue disorders, the underlying issue is often true instability of the rib complex itself. In many of those cases, fixation procedures such as the Hansen 3.0 method or other stabilization surgeries performed by experienced thoracic surgeons may absolutely be appropriate and life-changing. If you fall into that category, I highly recommend consulting multiple surgeons who have extensive experience specifically treating slipping rib syndrome before undergoing surgery. However, for patients without connective tissue disorders, I believe there is another option that deserves significantly more attention. The issue with slipping rib syndrome is not simply “the rib.” The real pain generator is the intercostal nerve being chronically irritated, compressed, or impinged by the rib movement itself. That distinction matters. It does not matter if you still feel the rib click or move — what matters is whether there is pain there. The movement itself is not necessarily the problem. The pain is.
Before undergoing a massive fixation or costal reconstruction surgery, I strongly encourage people to consult with a peripheral nerve surgeon. One surgeon I highly recommend looking into is Dr. Tim Tollestrup in Nevada. He is an absolute mastermind when it comes to peripheral nerve surgery and nerve-related pain conditions. Instead of reconstructing the chest wall, the focus can be directed toward the nerve itself through procedures such as neurolysis, mobilization of the nerve, burying the nerve into protective tissue such as fat, or in select cases resecting the nerve entirely. Compared to large fixation surgeries, these procedures are DRAMATICALLY less invasive with substantially faster recovery times. Obviously, treatment decisions are patient-specific, and no single operation is right for everyone, including those with connective tissue disorders. But I truly believe this approach deserves FAR more attention.
Pain medicine is evolving rapidly, and the future is increasingly centered around nerves. A great example is knee denervation. Some patients with chronic knee pain can now avoid or delay a total knee replacement by targeting the sensory nerves supplying the knee instead of replacing the joint itself. The target becomes the pain pathway rather than massive structural reconstruction. I believe slipping rib syndrome should be viewed similarly in many cases. If the rib movement is irritating the nerve, then addressing the nerve directly may be treating the actual root cause rather than working around it with a major reconstruction surgery.
This is obviously not medical advice, and I am not saying fixation surgery is wrong. For many patients, especially those with connective tissue disorders, it may absolutely be necessary and appropriate. I am simply posting this because I wish someone had discussed this possibility years ago when I was searching for answers myself. I would not be taking the time to write this if I did not genuinely believe there are patients out there who could benefit from hearing it.