Expert: Dr. Victor Dolan, DC, DACBSP - 4/11/2008

Question
I'm nearly 16 years old and my ribs click just under the heart on the right side, lastnight it was clicking when I breathed, bent forward, bent back, laughed or coughed and it sometimes gets painful. I've never had an serious injurys to my ribs and it's only been going on for about a month is there something wrong with my ribs?

Answer
Hello, sorry to hear of your ribs hurting.  "Pain" anywhere is not normal. 'pain' is a reaction to some kind of problem, some kind of damage.  "...Is there something wrong with my ribs?...", yes something is wrong.

Something horrible, terrible, no, probably not.  Something that needs attention?,  yes, since you say it has been here for a month, and it hurts, clicks when you breath, bend, laugh or cough.  Certainly you need a health care provider to evaluate you.  Your family Doctor of Chiropractic (DC) or Medical Doctor (MD), either would be a good place to start.

"No injurys", so I am assuming no trauma to the area.  Even without 'trauma', I am going to question you especially on your activity level.  Are you sedentary?, active, very active? Compete? Compete in contact sports?  Football, Basketball, Soccer, Rugby, lacrosse? Compete in other sports, gymnastics, golf, tennis?  Something I did not name (please do not take offense)?

Do you work out?  Did you notice this after some activity?  Did you notice this after some ""trauma""- no matter how mild.  Did you notice this after trying a new activity?  Did you notice this after doing a lot of an old activity?  Is the pain/ clicking getting progressively better or progressively worse?

The ribcage (similar to an earlier answer of mine) is important.  The ribcage houses and protects internal organs such as the heart and lungs.  Pain and/or clicking could indicate a heart or lung problem.  In all probability no heart or lung problem exists, BUT our heart and lungs are of such importance, we certainly want to listen to your heart and lungs and evaluate their possible involvement.  Again, it does not sound as if they are, but your DC or MD will certainly check for that.

No trauma,,, again, did you do a new activity or step up in an old activity?  Perhaps repetition is part of the problem and you 'sprained or strained' your ribcage, particularly at the costo-chondral junction.  'Clicking', you feel/ hear the ribs moving in your anterior right ribs?  Breathing problems- just with that right rib area?, any congestion in the lungs?  Any problem in the back- particularly in the back, near the spine, along the same rib line that hurts in the front?

You msy have diagnosed yourself properly.  After ruling out the heart, lungs, possibly the gallbladder (on the right side, upper stomach, lower chest, could give a pain, but not a click), you may have a problem specific to the ribs.  Unilateral? = one-sided?, just the right side? You mention heart, you mention right side, Heart is primarily left sided.

You may have diagnosed yourself correctly with 'clicking rib syndrome',  also known as 'slipping ribs'.  Doctors of Chiropractic,
trainers, physical therapists, orthopedists and physiatrists will be familiar with this diagnosis.  Once the bad things like fracture, heart/ lung/ even possibly gall bladder have been ruled out (and can be ruled out quickly by physical exam when you see someone in person), "Slipping Ribs" can be the diagnosis.

Slipping ribs are checked for by something called a hooking maneuver. Your DC or MD will examine you and see if your ribs, at the costo-chondral junction are loose- if the ribs 'click in/ click out of position.  The doctor will literally grasp your ribs and pull anterior- pain or clicking equals a positive test for rib hypermobility ('loose ribs' at the costochondral or possibly the sternocostal junctions).

IF you have slipping rib syndrome, like all conditions it can be mild/ moderate/ severe.  Rest and avoiding activities that elicit the pain could, over time, cure the problem.  If bad enough perhaps physiotherapy and taping (ask for kinesiotaping at the DC's office)could suffice.  If very severe, if very longstanding then perhaps surgery could be necessary, but do not jump to that conclusion please.  

This does sound musculoskeletal.  Immediately I would go to the 'PRICE' method: Protection of the injured area, Rest the injured area, Ice the area, Compression and Elevation- the last two steps, I would not worry about at this time.

Let your family DC check you out.  IF referral is needed, perhaps a thoracic surgeon or orthopedist could give an evaluation.

Thanks.  Good Luck.  Problems breathing are big problems, get checked immediately.  'Clicking', mild pain, you do not have to rush....

All that being said, sorry- in today's society I have to write:
 This is not meant as specific advice or prescription for this or any other patient.  This article is for general discussion and informational purposes only.  Evaluation by appropriate health professional should be made physically.  No doctor/ patient relationship exists within this interaction.

Again, Good Luck.

Victor Dolan, DC
http://www.DocDolan.net