A “dislocated rib” generally refers to a partial misalignment or separation of a rib from its normal attachments, not a full bone-to-bone joint dislocation. Medically, this painful condition is called rib subluxation or costochondral separation. A true dislocation of a rib from the spine is rare and typically only occurs following severe trauma. The more frequent injury involves the connective tissue or cartilage, leading to immediate, sharp discomfort and restricting movement, particularly those involving the chest wall.
Anatomy of the Rib Cage and Types of Displacement
The rib cage is a flexible structure made up of twelve pairs of ribs that connect to the thoracic vertebrae in the back. These ribs are classified based on their anterior attachment: the top seven pairs are “true ribs” and connect directly to the sternum via costal cartilage. The next three pairs, the “false ribs,” connect indirectly by attaching to the cartilage of the rib above them, while the last two pairs are “floating ribs” and have no anterior attachment.
The most common rib issues referred to as a “dislocation” are subluxations, which are partial misalignments that can occur at the joints near the spine or, more frequently, at the front of the chest. Subluxation often affects the posterior costovertebral joint, where the rib meets the vertebra, or is an interchondral subluxation involving the cartilage tips of the false ribs. This latter form is sometimes called Slipping Rib Syndrome, where the hypermobile cartilage tip of a lower rib moves or “slips” beneath the rib above it.
A costochondral separation involves a tear or detachment of the rib from the cartilage that connects it to the sternum or to another rib. This injury is a separation of the bone from the cartilage at the costochondral joint, often resulting from a sudden, forceful impact. Unlike a subluxation, where the rib is merely partially out of place, a separation involves damage to the connective tissue itself.
Recognizing the Signs and Common Causes
The pain associated with a rib displacement is typically sudden, sharp, and intensely localized at the site of the injury. This initial, stabbing pain often gives way to a persistent, dull ache that is aggravated by movement, breathing, or changes in body position. A distinctive symptom often reported is a palpable or audible “popping,” “clicking,” or “slipping” sensation when the rib momentarily moves out of its alignment.
The discomfort is significantly heightened by respiratory movements, making deep breaths, coughing, sneezing, or laughing a painful experience. The partial displacement can irritate the intercostal nerve that runs along the underside of the rib, which is the source of the sharp, radiating pain. Tenderness is usually present when pressing directly on the affected joint or cartilage.
These rib injuries result from two main types of force: direct trauma and sudden, indirect strain. Direct trauma, such as a fall, a blow to the chest, or a sports impact, can forcefully separate the rib from its anchor point. Indirect strain is a common mechanism for subluxation, including powerful, repetitive movements like those seen in rowing or golf. Poor posture or repetitive, asymmetrical twisting movements can also place undue stress on the rib joints over time, leading to a gradual weakening and eventual subluxation.
Professional Diagnosis and Treatment
A medical professional begins the diagnostic process with a thorough clinical examination, including careful palpation of the rib cage to pinpoint the maximum tenderness. For suspected Slipping Rib Syndrome, a specific physical maneuver called the “hooking maneuver” may be performed, which involves gently hooking the fingers under the lower rib margin to reproduce the characteristic pain and clicking sensation. Imaging is usually ordered to rule out more severe injuries, such as a rib fracture or a collapsed lung.
While static X-rays are excellent for detecting bone fractures, they are often insufficient for visualizing soft tissue damage like cartilage tears or subtle subluxations. In these cases, a dynamic ultrasound may be used, allowing the clinician to observe the rib moving in real-time to confirm a subtle “slipping” or partial displacement. Once the diagnosis is confirmed, initial treatment focuses on pain control and preventing respiratory complications.
The modified RICE protocol is adapted for rib injuries, focusing on rest from aggravating activities and localized icing to reduce inflammation. Pain management often involves nonsteroidal anti-inflammatory drugs (NSAIDs) to help control discomfort and allow for normal breathing. Supported breathing exercises are also important, often by holding a pillow firmly against the injury when coughing, to prevent the shallow breathing that can lead to chest infections.
For a rib subluxation, professional intervention by a physical therapist or chiropractor may involve manual therapy techniques to gently mobilize and realign the joint. This manipulation is designed to restore the rib to its proper articulation, which can provide immediate relief in some cases. Recovery for a non-surgical rib subluxation or separation typically requires six to eight weeks, during which time activity restrictions, such as avoiding heavy lifting and contact sports, are mandatory to allow the damaged soft tissues to heal fully.