Ligaments that may be involved:
(1) sternocostal (holding rib to sternum)
(2) costochondral (holding rib to its cartilage)
(3) costovertebral and costotransverse (holding rib to vertebral body)
Ribs at greatest risk for the injury: usually the 10th rib, but also the 8th and 9th rib
A rib that is loose in front is usually also loose posteriorly.
Clinical features:
(1) history of blunt trauma to the rib cage
(2) persistent pain in the traumatized area (chest, upper back, upper abdomen)
(3) pain may be worsened with deep breathing
(4) pain and/or paresthesias may radiate into the arm on the same side
(5) point tenderness may be present over the affected rib
(6) radiographs are negative for rib fracture
(7) asymmetry in the ribs or rib movements may be observed
(8) a positive hooking maneuver (pain is produced by the examiner hooking the fingers under the affected rib and pulling forward and up underneath the costocartilages of the rib immediately above)
(9) costochondral blockade provides symptomatic relief
(10) complete resolution occurs after surgical resection of the slipping rib
Exclusions:
(1) rib fracture
(2) cervical disk herniation
