New technique offers lasting relief for slipping rib syndrome

In 2016, Zach Wawrzyniak sustained a rib injury while practicing jiu-jitsu. What began as a minor incident led to years of persistent pain in his back, shoulder and ribs – pain that wasn’t always excruciating but was enough to disrupt his daily life.

“It wasn’t debilitating, but it was disabling,” he said.

Despite searching for answers over the years, Wawrzyniak didn’t undergo surgery when he first considered it in 2020. At the time, the surgical options didn’t seem promising. But by early 2025, determined to finally get relief, he revisited his search. That’s when he came across the name Dr. Taylor Ripley in a Facebook support group for people living with slipping rib syndrome.

Ripley, a thoracic surgeon at Baylor Medicine in Houston, is one of the few physicians in the country performing an advanced procedure known as costal margin reconstruction – a more durable approach to treating this painful and often misunderstood condition.

“Dr. Ripley explained that I may have already had a preexisting issue, and the jiu-jitsu injury just made it worse,” Wawrzyniak said. What convinced him to move forward was the surgical method itself: it involved using the patient’s own rib cartilage, along with a dissolvable metal plate for stability. The goal is to provide long-term pain relief while preserving flexibility for breathing.

What is slipping rib syndrome?

Slipping rib syndrome occurs when one or more of the lower ribs become overly mobile due to weakened or damaged cartilage. This allows the rib to slip out of its normal position and irritate or compress nearby nerves. The result is often sharp or stabbing pain in the lower chest, upper abdomen, back or shoulder – especially with twisting or bending.

Symptoms may include:

• A popping or clicking sensation in the ribs.
• Radiating pain in the back or shoulder.
• Discomfort made worse by movement.
• Difficulty with deep breathing or daily activities.

While some patients manage symptoms through physical therapy or injections, others –like Wawrzyniak – find no lasting relief until surgery.

Traditional surgical treatments for slipping rib syndrome include sutured repair, which may offer temporary relief but can break down over time and cartilage excision, which involves removing the damaged cartilage but may result in recurring pain if the ribs remain unstable. A newer and more durable option is costal margin reconstruction, which involves removing the painful cartilage and autotransplanting a portion of it between the ribs to prevent further nerve impingement. Ripley’s approach to this procedure includes securing the rib and cartilage with a dissolvable plate, which supports healing while maintaining enough flexibility for normal breathing.

For Wawrzyniak, the decision to undergo costal margin reconstruction was life changing. He was able to return home the same day of surgery and, most importantly, he finally was free of the disabling pain that had followed him for nearly a decade.

“I’m just happy I finally did it,” he said.

By Tiffany Harston, senior communications associate in the Department of Surgery