Slipping rib syndrome
Pain from the lower ribs, often with a click, worse with twisting and bending. Slipping rib syndrome →
Costochondritis · chest wall joint painCostochondritis is inflammation of the joints where your ribs meet the cartilage at the front of the chest — one of the most over-used labels in chest wall medicine. A fair share of the people told they have it actually have something else.
Page last updated September 2026
Costochondritis has a fairly recognisable pattern. Any of the following is worth a proper look:
“If you have been given the label but nobody has actually examined your chest wall, that is the first thing to put right.”
Mr Marco Scarci, Consultant Thoracic Surgeon
Often no cause is found. When there is one, it is usually a strain: a spell of hard coughing, repetitive lifting, an unaccustomed sport, heavy pushing exercises, or a viral illness.
Occasionally costochondritis is one feature of an inflammatory arthritis such as ankylosing spondylitis or psoriatic arthritis — worth considering when it keeps recurring or you have back or joint symptoms elsewhere.
Each of your upper ribs joins the breastbone through a short bar of cartilage. The joints at either end of that cartilage — where rib meets cartilage and where cartilage meets breastbone — can become inflamed and tender. That is costochondritis. It most often affects the second to fifth ribs, frequently more than one at a time, and usually on one side.
In emergency departments and GP surgeries, “costochondritis” has become shorthand for any front-of-chest pain once the heart has been ruled out. The diagnosis is frequently made from the doorway, without the chest wall being examined properly. Conditions that regularly get filed under it include:
Pain from the lower ribs, often with a click, worse with twisting and bending. Slipping rib syndrome →
After a fall, a tackle or a heavy lift — and never show on an X-ray. Costal cartilage injuries →
Tenderness at the small bony tip at the bottom of the breastbone, rather than at the rib–cartilage joints themselves.
Unlike costochondritis, Tietze syndrome does cause a visible swelling over the affected joint.
Burning, band-like nerve pain rather than joint pain. Intercostal neuralgia →
Sternoclavicular joint problems, muscle strains, and pain referred from the spine.
The distinction matters because the treatments differ. Costochondritis never needs surgery. A separated cartilage may need proper rehabilitation, and sometimes repair. Slipping rib syndrome has a specific surgical solution.
Costochondritis is a clinical diagnosis: it is made by taking a careful history and examining the chest wall by hand, junction by junction. There is no test that proves it.
Tests exist to rule other things out. Depending on your age and symptoms that may mean an ECG and blood test to exclude the heart, an ultrasound scan (which shows the swelling of Tietze syndrome, cartilage injuries, and a slipping rib when scanned during movement), a CT scan if a fracture is suspected, or blood tests for inflammation if an arthritis is on the list.
In genuine costochondritis, all of these tests are normal — and normal results are reassuring rather than a dead end.
Anti-inflammatory tablets or gels for a couple of weeks, if they are safe for you; heat over the sore area; and a short break from whatever provokes it — heavy pushing exercises, the offending sport — then a gradual return.
Stretching, posture work and physiotherapy when it lingers, particularly if you sit hunched at a desk all day.
For a persistent, single, clearly tender junction, an injection of local anaesthetic and steroid directly into it can give lasting relief. It also doubles as a test: if numbing that joint abolishes the pain, the diagnosis is confirmed.
If pain persists after all of that, the honest next step is to question the diagnosis rather than repeat the treatment. Surgery is essentially never the answer for true costochondritis. If an inflammatory arthritis is found to be behind it, treatment of that condition is what settles the chest.
you are struggling to breathe, or breathing is getting worse; you are coughing up blood; you have crushing or tight chest pain, or pain spreading to your arm, jaw or back, with sweating or faintness; or you feel dizzy or faint, or have severe abdominal pain after a chest injury. Call 999 or go to A&E. If you are unsure, call 111.
Any of the following is a good reason to be seen, rather than to repeat what hasn’t worked so far.
MD(Hons) · FRCS(Eng) · FCCP · FACS · FEBTS · Consultant Thoracic Surgeon, Imperial College Healthcare NHS Trust
Mr Scarci holds an NHS consultant post at Hammersmith Hospital, Imperial College Healthcare NHS Trust, and runs a chest wall practice across London’s leading private hospitals. He has performed more than 5,000 procedures at consultant level since 2011 and treats rib and chest wall injuries every week, from acute trauma to the long-standing pain that other tests have failed to explain.
No GP referral required. Bring any old letters or scans — the history of how it started matters.
St John’s Wood, NW8 9LE
11:00am–1:00pm Monday PMMarylebone, W1G 6BW
5:30–7:30pm Tuesday PMBorehamwood, WD6 3BS
5:30–7:30pm Wednesday AMHammersmith, W12 0HS
9:00–11:00am Thursday AMSouth Kensington, SW5 0TU
9:30am–12:30pmNot in London? Remote video consultations are available to review your history before you travel.
Lower rib pain with a click, worse with twisting and bending.
TraumaticFractures and separations after a fall, tackle or heavy lift.
Nerve painBurning, band-like nerve pain rather than joint pain.
UnexplainedRib and chest wall pain that other tests have failed to explain.
Not sure which page applies to you?
No. It is a benign, self-limiting condition of the chest wall, not the heart or lungs. That said, chest pain should always have heart causes excluded first when your age or symptoms warrant it, and any chest pain with breathlessness, sweating or pain spreading to the arm or jaw is an emergency.
Most cases settle within a few weeks. Some take two or three months. If it has been longer than three months, or it keeps coming back, it deserves a proper reassessment rather than more of the same.
Generally yes, guided by pain. Walking, cycling and running are usually fine. Avoid heavy pushing and pulling through the chest (bench press, press-ups, heavy rowing) for a couple of weeks, then reintroduce them gradually.
Tietze syndrome causes a visible, tender swelling over a single joint, usually the second or third rib. Costochondritis causes pain without swelling, often at several joints. Both are benign; Tietze tends to take longer to settle.
For a persistent single tender junction, an injection of local anaesthetic and steroid is often effective and confirms the diagnosis at the same time. It is not a first-line treatment and it is not routinely repeated.
If the pain is in the lower ribs, clicks or catches, or is worse with twisting and bending rather than with breathing, slipping rib syndrome is the more likely diagnosis. It is confirmed by examination and treated differently, so it is worth being seen.
A consultation with Mr Scarci is a hands-on examination by a surgeon who treats the chest wall every week, with imaging arranged on the same visit where it will change the plan.