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Twelfth rib syndrome, also known as rib tip syndrome, is a painful condition that occurs as a result of highly mobile floating ribs. It commonly presents as pain that may be felt in the lower back or lower abdominal region as a result of the 11th or 12th mobile rib irritating the surrounding tissues and nervous systems.
Costochondritis, also known as chest wall pain syndrome or costosternal syndrome, is a benign inflammation of the upper costochondral (rib to cartilage) and sternocostal (cartilage to sternum) joints. 90% of patients are affected in multiple ribs on a single side, typically at the 2nd to 5th ribs. [1]
Iliocostal friction syndrome, also known as costoiliac impingement syndrome, is a condition in which the costal margin comes in contact with the iliac crest.The condition presents as low back pain which may radiate to other surrounding areas as a result of irritated nerve, tendon, and muscle structures.
It can feel like a fracture, and it can cause pain for weeks, but the rib bone is not broken” says Vasudevan. Less commonly, right rib pain can be a sign of a stress fracture or full-on bone break.
The presentation of slipping rib syndrome varies for each individual and can present at one or both sides of the rib cage, with symptoms appearing primarily in the abdomen and back. [3] Pain is most commonly presented as episodic and varies from a minor nuisance to severely impacting quality of life.
Tietze syndrome affects the true ribs and has a predilection for the 2nd and 3rd ribs, commonly affecting only a single joint. In environments such as the emergency department, an estimated 20-50% of non-cardiac chest pain is due to a musculoskeletal cause. [1]
The lateral part of the CVA is formed by the lower border of the 12th rib, and the medial part of the CVA is formed by the transverse processes of the lumbar vertebrae. [1] The CVA is distinct from the costovertebral joints. [2] The lower poles of the kidneys are within the CVAs. [1] A small amount of pleura extends below the ribs in the CVAs. [2]
Treatment is usually via reassurance, as the pain generally resolves without any specific treatment. Occasionally it goes away after a couple of breaths. [1] The pain is agitated by expansion and contraction of the chest. Taking a deep breath and allowing the rib cage to fully expand can relieve the pain, however it will feel unpleasant initially.