Slipped rib syndrome

I wasn’t sure whether to post this topic since I don’t know whether it is appropriate for this forum, but I figured I’d share it since I think it is relevant to my condition and others may find it helpful.

I strongly believe I have a condition called Slipped Rib Syndrome that could be a very important underlying piece of the puzzle for me. I have had chronic low back pain for many years that predates the diagnosis of thoracic outlet syndrome and Eagle Syndrome that hasn’t been explained by looking at my lumbar spine anatomy. It hasn’t been relieved by:

  • Chiropractic
  • Massage
  • Stretching
  • Physical therapy
  • PRP/Prolotherapy injections

I recently came across this video by Dr Adam Hansen that seemed to connect some dots for me:

Furthermore, upon joining the Facebook Group for Slipped Rib Syndrome, it seems that a lot of people with this condition also develop Thoracic Outlet Syndrome, as well as other vascular compressions, most notably MALS.

The way this seems to work is that:

  1. Due to chest wall injury a person develops a slipped 10th rib, and possibly 9th rib. They become detached from the costal margin and become “floating”. They move around and irritate the intercostal nerves and sometimes poke the diaphragm.
  2. This affects breathing since the diaphragm attaches to the bottom ribs and the slipped ribs create inflammation and irritation to the diaphragm. People then cannot breath as fully into the lower part of their lungs and instead compensate by breathing into their upper lungs utilizing the scalene muscles.
  3. Often people develop weak abdominal and lower back muscles because the slipped ribs are constantly irritating the intercostal nerves and therefore the movements required to strengthen the core cause intense pain.
  4. The combination of weak core muscles and altered breathing mechanics changes posture and can cause the shoulders to round and alteration of the cervical spine alignment.

The connection to MALS seems to be that an alternation of the diaphragm function or position could alter to median arcuate ligament anatomy such that it begins to compress the celiac artery.

In my case, I had thoracic outlet syndrome decompression surgery and my surgeon (Dr Gelabert at UCLA) noted that my scalene muscles had “hypertrophied” to roughly four times the normal size. As most of us know, scalene muscles can cause compression of the brachial plexus and subclavian vein/artery, as well as be involved in jugular vein compression.

In my case, I suspect slipped ribs at the bottom of my ribcage had altered my breathing mechanics such that my scalenes became overdeveloped and I started having the compression disorders in the neck that I continue to have (though some symptoms improved after thoracic outlet decompression surgery).

As far as what my next steps are, I clearly need to address the jugular outflow problem in my neck, as well as the possible CSF leak(s), but I may need to address the slipped ribs if that truly is a major underlying cause of my problems.

I had a recent chest CTA and I used that to create a 3D model. With a 3D reconstruction, you can usually see the cartilage and thus see if it is detached from the costal margin. In my case, it looks like the 9th and 10th ribs are “floating” or slipped.

I have an appointment with Dr Joseph Forrester at Stanford in late August, about two weeks after I see Dr Hepworth for the first time. He should be able to tell me whether I have this or not.

Has anyone else had any slipped ribs, or other ribcage anomalies? Apparently this condition is more common among those with Ehlers-Danlos syndrome (which I don’t think I have).


Very interesting post, @jrodefeld. Thank you for sharing this information. It’s indirectly related to ES so I think appropriate on our forum & may be very helpful for others here.

I’m sorry if you have this problem to add to the others you’re dealing with but it’s always good when the cause of pain is discovered so it can be dealt with rather than living with pain or masking it with medication.

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The good news is that Dr Adam Hansen, who is featured in the video I posted, has pioneered new, less invasive means of treating this condition and the results seem to be extremely effective at curing the problem for most people.

The difficult thing when dealing with multiple rare conditions that have been developing over years is figuring out what is causing what symptom. The only way to know for sure is to treat one problem and resolve it, then see what is left.


this is really interesting! one of my lower ribs has always “popped in and out” of place. i can move them with my hands which used to freak my ex out haha. i don’t have much acute pain in that area, though i’ve had low back pain since i was a preteen and some digestion problems.

Though I have always gotten severe stomach pain, like bad period cramps, after running long distances (which i haven’t done in a long time because of that and joint pain), particularly when I stop running abruptly without walking for a while. Does that sound like it could be MALS?

i have IJV compression and very likely TOS. I also think I have CCI.

I’m a patient of Dr. H and am seeing him the week after next so i might bring this up to him.

I’m still trying to learn all the acronyms and related conditions. It seems like there’s an infinite amount!


That’s really interesting & thanks for posting…we are seeing more members with other vascular compressions like TOS & Nutcracker, so another one to add to the list, & your explanation of how it’s potentially linked to ES sounds sensible…Sorry that you have uncovered another potential medical issue, but good that hopefully you’re getting closer to sorting some of these out!

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@Clarebear That’s really great that she was able to get better, do you happen to know if they did the Hansen technique repair?

The results Dr Hansen seems to be getting with his costal margin reconstruction are extremely encouraging, people seem to be getting pretty much completely better.

I’ll be seeing Dr Joseph Forrester at Stanford in late August to get evaluated. I have a tentative appointment with Dr Hansen in December, but I may not need that appointment depending on how it goes with Dr Forrester.

And all of this is dependent on how my appointment goes with Dr Hepworth in early August.


what did they find if you don’t mind me asking?

I’m not sure what technique was used but she described it as a shoelace across her ribs.

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I’m not certain, apologies.