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Everybody has floating ribs.

A rib is said to be floating if it is not attached to the breast bone (sternum), and it's not attached to another rib, either.

There are (usually) 12 pairs of ribs. Each rib is attached at the back to the spine. The first seven pairs of ribs are also attached to the sternum. They are known as true ribs. The next five pairs of ribs are not attached to the sternum, and are known as false ribs

The first three pairs of ribs are attached by cartilage to the ribs above them. The second two pairs of ribs are not attached to other ribs (although they are attached to the spine), and are said to "float." They are also known as vertebral (because they are attached to a vertebra of the spine) or fluctuating ribs.

These last two ribs aren't as completely connected to surrounding bones, so they are much more susceptible to injury. There's even a condition known as "floating rib syndrome." This doesn't mean that the rib is just floating around in your abdomen, but as a result of injury it may become intensely painful. This condition of rib pain is also known as slipping rib cartilage, rib-tipping, nerve nipping, and clicking ribs.

It's not especially difficult to diagnose floating rib syndrome. If you stick a finger behind the "loose" rib, you can move it. (This will hurt, usually a lot.) The dislocation of the rib will also be easy to detect on X-ray. The deformity causes pain in front of the rib, usually just on the left side or just on the right side, that gets worse with any kind of activity that requires heavy breathing.

There is usually a specific injury that someone who has floating rib syndrome can remember. Pain does not start right away. The pain and swelling may not appear for several months. There may be a "click" of slipping cartilage during certain kinds of movements. Sometimes a chiropractor can pop the rib back into its socket, but usually the rib has to "find" its way back into its proper position slowly. The pain can then last for several more months. 

Treatment for floating rib syndrome consists of:

  • Lidocaine injection when the condition is first diagnosed and during acute exacerbations of pain later.
  • An intracostal nerve block for chronic pain.
  • Surgical removal of inflamed cartilage around the floating rib in the most severe cases.

Fortunately, simply knowing you have the condition can help you remember to avoid the motions and positions that cause severe pain. Aspirin or Tylenol may be enough to control pain.

Floating rib syndrome most often occurs before 40. It usually affects just one rib on just one side of the body. Only 10 percent of cases involve two ribs. It is usually not associated with heart disease. A closely related condition called Tietze's syndrome may cause lower rib pain after a chest cold or severe asthma attack.

People over the age of 40 don't usually get floating rib syndrome. They are more prone to a condition called costochondritis. In over 90 percent of cases of costochondritis, more than one location in the rib cage becomes painful, and the pain is more likely to be concentrated in the second to fifth pairs of ribs. It can be hard to distinguish costochondritis from angina, and it is usually critical to rule out a heart issue before treating rib pain. Costochondritis can also be associated with a condition of generalized cartilage problems called fibrositis.

While a few people will have floating rib injuries for years on end, the pain caused by this problem will usually go away. If it doesn't, ask your doctor for referral to a physical therapist who can show you the moves that keep you from reinjuring your ribs and perpetuating the problem.

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