Slipping rib syndrome

I'm Marco Scarci, a consultant thoracic surgeon with a specialist interest in chest wall conditions. Including slipping rib syndrome, a condition which is often misunderstood. Slipping rib syndrome happens when the cartilage anchoring the lower ribs becomes too mobile. The 8th, 9th or 10th rib may shift out of place - and this movement irritates nearby nerves, causing sharp, sometimes disabling pain. It's also known as rib tip syndrome, or Cyriax syndrome. Patients often describe a sharp, stabbing or tearing sensation below the chest. You may hear or feel a clicking or popping sound. Pain usually worsens with movement, deep breathing, coughing or even laughing. It's frequently misdiagnosed as a cardiac, or gastrointestinal issue. One of the biggest challenges is that this condition doesn't show up on a standard scan. I've seen many patients told everything looks "normal" when the pain is anything but. Diagnosis relies on listening carefully to your symptoms and performing a simple, focused physical examination. A key test I use is called - the "hooking manoeuvre." I gently press under the lower rib margin and lift. If this reproduces your familiar pain or clicking, it confirms the diagnosis. It's a simple technique, but remarkably accurate when performed by someone familiar with the condition. Once diagnosed, many patients can manage their symptoms without surgery. We start with conservative options including: anti-inflammatory medication, rest, activity modification - and physiotherapy focused on breathing and posture. The goal is to calm the irritation and reduce strain on the rib joints. For some, pain may persist despite conservative treatment. In these cases, I often offer an image-guided nerve block or corticosteroid injection. This can reduce inflammation around the irritated nerve and help confirm the source of pain. Surgery is reserved for patients who remain in significant pain despite other treatments. I perform a minimally invasive operation where the unstable rib tip is removed or stabilised. In experienced hands, this has a high success rate, with many patients returning to full, pain-free activity. Recovery depends on your treatment path. After surgery, most patients go home the same day and resume light activities within days. Whether you have surgery or not, ongoing focus on posture, core strength and pain management will give you the best long-term outcome. If you've been living with undiagnosed lower chest pain, especially after movement or coughing, don't ignore it. Slipping rib syndrome is real. You deserve to be heard and treated properly. If you recognise your symptoms in what I've described, I encourage you to get in touch. With the right diagnosis and care, relief is possible - and for many, life-changing.