What is a rib-tip syndrome?

Rib-tip syndrome, also known as costo-iliac impingement syndrome, is described as pain felt in the flank at the level of the iliac crest (top of the hip bone) caused by the lowest rib touching the iliac crest, thereby causing pain.


If you are of advanced age and already have scoliosis (curved spine), curvature of the spine can increase, as you get older. As a result, the lowest rib on one or both sides (usually the 11th rib) can touch the iliac crest with its tip. This is also seen in osteoporosis where the vertebrae collapse and your back becomes lopsided.

Signs and symptoms

In rib-tip syndrome, the pain is usually evoked by static pressure such as sitting or standing for long periods of time, twisting the trunk, and walking. The pain is felt on one or both sides, at the level of the iliac crest.

How is rip-tip syndrome diagnosed?

If you have the pain described above, a neurological examination will always be performed in order to exclude any other possible causes. In addition to the neurological examination, the movements of the upper and lower back are checked for limitation and pain. The end of the lowest rib is also examined in order to feel whether or not it is painful and whether it is close to the iliac crest. The spine is also examined to check for severe scoliosis. The upper and lower back is also examined to feel which vertebrae are painful when pressure is put on them.

Do I need any additional examinations?

  • Diagnostic examination for other non-physical factors important to your pain already took place  after you filled in your pain questionnaires.
  • X-rays and MRI scan are performed to exclude other causes.
  • You may be referred to a pulmonologist or an internal specialist.

What are my treatment possibilities?

Multidisciplinary Treatment

Depending on the cause of your pain, your pain specialist will decide whether or not to embark on physical treatment. Based on the results of the completed pain questionnaire, additional examinations can be carried out and, apart from physical treatment, other methods of treatment will be suggested.

Non-physical Treatments

If the results of your pain questionnaire are abnormal, your pain specialist will offer you one of the non-physical treatments listed below:

Physical Treatments


Other Treatments

Interventional Pain Treatments

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