chronic pain

Why Aren’t More of Us Talking About Slipping Rib Syndrome?

Photo-Illustration: The Cut; Photo: Getty

Swellness is a monthlong series exploring the health and wellness stuff no one talks about.

Sammie Hart was 15 when she first felt intense, sharp pain on the left side of her rib cage. “I was on my high-school dance team, and every time I would do vigorous exercise, the skin around my ribs would swell and turn red,” says Hart, who’s now 26. Dance, after that, was out of the question — in a flare-up, she struggled to breathe and lie on her side, let alone move.

X-rays didn’t reveal the cause of her pain, and physical therapy didn’t bring long-lasting relief. Two years and multiple doctors later, a surgeon at the University of Minnesota diagnosed her with a rare condition called slipping rib syndrome (SRS), a condition that causes ribs to dislocate and irritate surrounding nerves that experts say primarily affects women.

While SRS has been described in medical literature for more than a century, it’s still poorly understood and often misdiagnosed. Because SRS is relatively unknown among doctors, many of whom already have a general distrust of women’s complaints, patients like Hart often lose months or years of their lives dealing with and trying to figure out the cause of their pain.

Below, an FAQ-guide to everything you need to know about SRS.

First, what is slipping rib syndrome?

The majority of your rib cage is bone, but the area surrounding your sternum — the long bone in the center of the chest wall — is made of cartilage; the connective tissue allows your abdomen to expand when you breathe or move.

Slipping rib syndrome happens when the cartilage portion of a person’s lower ribs becomes dislocated — “slipping” apart — and irritates the surrounding nerves and tissues. People with SRS inevitably experience severe pain in the area of the slipped rib, but these nerves also send pain signals throughout the back and abdomen. “Even a simple movement or breath can rub the nerve like a banjo string and create pain in multiple sites,” says Adam J. Hansen, a cardiothoracic surgeon at the West Virginia University Heart & Vascular Institute.

Anyone can get SRS, but Hansen says nearly 80 percent of the patients he’s treated have been biological women. Some have a musculoskeletal condition called Ehlers Danlos syndrome, which results in overly mobile muscles and tissues. (This condition also primarily affects women.) Pregnancy can cause ribs to dislocate, too, as can any kind of trauma to the ribs — for example, a car accident, falling on ice, or even routine tasks like cleaning or shoveling.

In a viral TikTok that shows a woman’s lower-right rib protruding from her midsection, she asks, “Does anybody know what this is? NO doctor I’ve seen knows.” Numerous women commented that they experienced the same thing after having babies (some of them for years without an explanation). “This has been happening to me ever since I had my son,” one person replied. “Nine years I have been dealing with this. What do we do about it?”

What’s it like living with slipping rib syndrome?

Heather Dobos, a 37-year-old mom from Minnesota, says her SRS caused debilitating pain and pressure in her stomach area, especially when she ate or drank. “I would take a drink of water and hear these god-awful noises in my stomach, and when I ate, it always felt like something was in the way or like I was already full,” she says. Even though she ended up losing 40 pounds and developing major anxiety about eating, doctors couldn’t find a gastrointestinal cause after multiple endoscopies and colonoscopies, which only fueled Dobos’s anxiety.

Because movement often increases SRS pain, people often stop doing things they enjoy, which can threaten mental health even more. Becky, 28, a medical student in England who asked us not to use her last name, says her pain caused her to stop exercising — she spent most of her time lying down, which caused her body to lose muscle tone. “I had to take a year off from university, because I was in bed most of the time, which caused me a lot of anxiety and depression,” she says.

Even routine activities can be hard for a person with SRS. Because twisting in the shower hurt too much, Becky used wet wipes to freshen up. She also took prescription painkillers for years because doctors didn’t know any other way to treat her. While they helped take the edge off the pain, she suffered unwanted side effects of the medication — primarily fatigue and constipation. For Andrea Taylor, a 30-year-old from Ontario who was diagnosed with SRS after being hit in the ribs with a basketball, the pain in her chest drastically impaired her sleep. “I’d have to sleep with my elbow dug into my other ribs to line them up.”

Like many other chronic illnesses, SRS is hard to diagnose, adding another layer of stress. Hansen says many of his patients have seen 30 to 50 doctors, many of whom dismiss their pain or, at best, recommend ibuprofen and ice. “This is probably one of the most underdiagnosed conditions people have,” he says. “People just swirl around for years trying to figure out what’s causing their symptoms.”

SRS was first recognized by a British orthopedic surgeon in 1919, but the condition is still relatively unknown among medical providers; Hansen says it’s not common for doctors to learn about it in medical school. The fact that the condition affects multiple areas of the body also makes it hard to pinpoint, often contributing to misdiagnosis. It’s not uncommon for patients to undergo unnecessary (and expensive) procedures, such as spine MRIs, endoscopies, exploratory surgery, and even gallbladder removal to solve the problem.

SRS patients often find out about the condition themselves through online research. Dobos in Minnesota saw doctors for years — and underwent an unnecessary gallbladder removal — before she stumbled across SRS online. A physical therapist confirmed the likelihood of the condition with an ultrasound. Becky’s story is similar: She found a research paper online about SRS, but multiple doctors pushed back until she finally found one who believed her.

How do you fix it?

Unlike bone, cartilage typically doesn’t heal itself — so slipping rib syndrome typically creates chronic, often debilitating pain until it’s repaired. But that can take a long time to happen. And for those with severe pain, surgery is often the only long-term solution.

Luckily, Becky’s doctor was one of few surgeons in the country who perform surgery on slipped ribs by reshaping the cartilage so it doesn’t irritate the nerves around it. For years, the surgery was done by removing the slipping piece of cartilage, but that version of the surgery typically doesn’t lead to long-term relief. Plus, “resected cartilage can grow back as bone, or scar tissue forms, which can cause further nerve irritation,” says Adam Shiroff, a professor of clinical surgery at Penn Medicine and director of the Penn Center for Chest Trauma.

Now, a growing number of surgeons repair the cartilage instead, using permanent stitches to return the slipping area back to where it should be and prevent future nerve irritation. So far, it’s changing lives. Hansen first performed the surgery in 2021 on a 21-year-old patient who struggled with suicidal ideation due to his slipping rib syndrome. “I sutured his ribs back to the other ribs in a way that would avoid the nerves,” he says. “A few weeks later, when I saw him back, he was a whole new person.”

Hansen estimates 80 percent of his surgeries are successful — meaning only 20 percent require an additional surgery to move the dislocated rib — and the average patient he treats reports a nearly 50 percent improvement in quality of life in the year following the surgery.

All the patients we spoke to said surgery gave them back their bodies. Hart says she still experiences occasional pain, but it doesn’t impact her daily life like it did before, and she can work out without struggling like she did in high school. Taylor underwent the surgery in May 2022, and after plenty of rest and physical therapy, she’s regained function — she’s even training for a half-marathon.

And after her surgery with Dr. Shiroff, Dobos recently had a baby — something she worried she’d never be able to do when she was stuck in bed in constant pain. “I was a little scared the baby would kick me in the ribs and cause a problem during pregnancy,” she says. “But my doctor reminded me that I could reach out, because he knew how to fix it.”

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Why Aren’t More of Us Talking About Slipping Rib Syndrome?