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Case report
Slipping rib syndrome in an adolescent wrestler
  1. Irfan Chhipa1 and
  2. Quincy Cheesman2
  1. 1Rothman Orthopaedic Institute, Egg Harbor Township, New Jersey, USA
  2. 2Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Irfan Chhipa; irfan.chhipa{at}


Slipping rib syndrome is a commonly missed diagnosis of upper abdominal pain. It results from hypermobility of the anterior rib due to the disruption of the interchondral ligaments, most likely secondary to repetitive motions or some inciting event. The hypermobility leads to impingement of the intercostal nerves resulting in significant pain.

A 10-year-old adolescent male child was evaluated for 4 months of intermittent, left-sided, upper abdominal pain following a wrestling injury. His paediatrician referred him for further evaluation after a negative workup given the patient was still having intermittent bouts of short-lasting pain that would spontaneously resolve. Physical examination demonstrated a positive hooking manoeuvre with associated swelling and prominence over the lower left ribs.

In conclusion, a broad differential diagnosis, thorough clinical examination, and knowledge of slipping rib syndrome are important to appropriately diagnose and treat patients symptoms.

  • slipping rib syndrome
  • pediatric
  • abdominal pain
  • chest pain
  • hooking maneuver
  • dynamic ultrasound
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  • Contributors IC: design, revision and final approval; provided the basis of the patient’s information given he was the treating physician. QC: developed the paper with feedback and revisions from the primary author.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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