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Right side pain, under the ribs
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Right side pain, under the ribs

I’m a 35 y/o male, 178cm and 155 lbs. I’ve been experiencing right sided pain for about 6 months now. The pain is just under my right ribs. The pain radiates to my back as well. I’ve practiced weight lifting, swimming and karate for years. I'm completely unsure what caused it. It started as very minor pain, more like pressure. I’m fairly athletic and exercise 3-4 days per week, or used to… I haven’t been able to since I’ve had this side pain. The odd thing about the pain is that over few weeks it has gotten a lot worse, rather than getting better and since then stayed almost at the same pain level. This pain has stayed with me every single day for the last 6 months. It gets worse when I sit down. It’s not a sharp stabbing pain, it’s more of a severe ache. It feels like a warm/burning/almost tingly sensation on my right side. The pain goes over to the right side of my back, above my hip bone just below my ribs. It’s like my whole right torso is affected! I have a hard time sitting at my desk for work. Also, driving long distances is very uncomfortable and painful now. It feels like someone is poking me right below my right ribcage and I feel a lot of pressure and a pulling sensation on the right side of my back at times. My right oblique muscles are felt very tight on examination. When sneezing I feel a strong tingling in my right side. Sleeping on my right side doesn’t bother it at all, and when I wake up in the morning, the pain is pretty much gone! But of course within the first 10-15 minutes I start walking around a little bit and sitting down to eat my breakfast, it starts. It progresses throughout the day. (I have a desk job, and of course sitting makes it worse….) I can no longer exercise, all I can do is walk, and even that aggravates it sometimes. Food doesn’t seem to make any difference. What I eat doesn’t bother it. Nobody can figure out what I have. I’ve had many different types of blood tests, I’ve had a CT scan of my right side abdomen, a colonoscopy, an ultrasound of my right side and everything has shown up normal. I’ve been checked for kidney stones, gall stones, kidney problems, liver problems, gallbladder problems, but so far, everything is normal! I did go to physical therapy for a couple of weeks, but it did not help, it only caused me more pain. Same thing with a chiropractor. I have also tried acupuncture and injury massage therapy with no luck. I have booked an appointment for a neurologist, but the earliest one was for April, so I am just waiting and wondering what I should do meanwhile? Do you think I may have Thoracic Radiculopathy or something else related to nerve entrapment? What other diagnostic tests should I have? What medications should I take for the pain/treatment?

Thanks,

Vlad
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Avatar_f_tn
This is insane.  You just described me perfectly.  I have had all the same tests and also some cysts removed on my ovaries.  I did; however, just have a MRI of my abd and head.  My head MRI showed lesions consistant with MS.  I hope this is not the DX for either of us.  Just like you my appt is not until 3/31.  (a little sooner).  I wish someone other than me could have replied to you.  I thought you might have liked to know you're not crazy cuz that is what I was starting to think before the MRI.   Good Luck!  Gina
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Avatar_f_tn
This is insane.  You just described me perfectly.  I have had all the same tests and also some cysts removed on my ovaries.  I did; however, just have a MRI of my abd and head.  My head MRI showed lesions consistant with MS.  I hope this is not the DX for either of us.  Just like you my appt is not until 3/31.  (a little sooner).  I wish someone other than me could have replied to you.  I thought you might have liked to know you're not crazy cuz that is what I was starting to think before the MRI.   Good Luck!  Gina
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Avatar_n_tn
I'm afraid I don't have an answer either, but I do have this extreme discomfort or pressure (rather than pain) under my ribs on the right side, which has now been there for a year. I've had all sorts of tests, too, though not yet a colonoscopy (had a gastroscopy) or an MRI. I've also been to an osteopath with no result. It doesn't seem to be associated with food, though perhaps with gassiness. It's gets much more noticeable as the evening wears on and in bed, but I'm not aware of it every day. I've become paranoid about returning to the doctor as I'm sure they think I'm making it up, but at the same time I worry about it. I think I'll request an MRI, though they'll probably think I'm mad.
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Avatar_m_tn
Thanks for replying. I've just had MRIs of my abdomen and thoracic spine in Buffalo. I am in Canada, but I had to go to US and pay for the test to avoid the 3-4 months waiting time. The results will be send to my doctor next week and I have made appointment to see him. Meanwhile, I saw a neurologist, who told me to start neurontin (gabapenin) 400mg/bid, but he did not give me any definitive diagnosis. I take my health very seriously, but I am running out of options, the pain continues and I still do not have an answer. I have spent many hours researching the Internet and so far found, that my problem is either neurological (Thoracic Radiculopathy, caused by disk displacement, herpes zoster, tumor, MS, etc.) or abdominal muscle tear - sports hernia (athletic pubalgia). Somebody has sent me a private message, that he had similar symptoms and had an isotopic bone scan, which showed a tumor in his rib. I will report next week when the MRI results are available. Good Luck! Vlad
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Avatar_m_tn
I have got the MRI results from Buffalo and everything is normal, thanks God! As my family doctor put it, now we know what it is not, but we still do not know why I have the pain. He probably thinks I am crazy :) I am going to see a very good orthopedic surgeon in Toronto, who has a lot of experience with sport injuries. I believe it is an abdominal muscle tear - sports hernia (athletic pubalgia). Here is a big source of information about this condition, which ultimately requires a surgery to be fixed:
http://www.letsrun.com/forum/flat_read.php?thread=559820
BTW, I have stopped the neurontin, because it was making me tired and sleepy without any effect on the pain. Vlad

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Avatar_n_tn
Hi--I can't believe I am reading this! I have had the exact same tests, except for the MRI!  I have had the same pain as you for the last 8 months. Finally, I am going to see a surgeon on April 17th.  They are thinking it is a ventral hernia.  I hope I finally have an answer! Keep us updated on your situation.
AV
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Avatar_m_tn
Here are some new developments today. I have received the results from the scrotum ultrasound and they found "prominence and echogenicity involving the right epididymal head which measures about 7 mm. These findings are consistent with regional or focal epididymitis". My STD urine samples came back negative as expected. Could this be a scrotal hernia caused by my heavy lifting?
My family doctor has prescribed Cipro 500 mg bid for 10 days. He does not think the pain is related to the right side lower abdominal pain and tingling, but I think he is wrong. I had this sensation of swelling in the groin area and pain, approx. since my abdominal pain has started. But I do not think at this point there is a bacterial reason. If this is epididymitis, it is probably chronic. Interesting enough, on the CT scan I had 4 months ago, they mentioned enhanced 9 mm Meckel diverticulum and suggested possible Meckel diverticulitis, but the surgeon neglected it. Was there some infection going on related to the whole picture?!? I will ask for urological referral, but meanwhile how do you think I should proceed?

Thanks,

Vlad
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Avatar_m_tn
Update: My costochondritis diagnosis was made by the doctors at the Sunnybrook Pain Management Clinic, after reviewing all diagnostic tests I have collected for the last 10 months - MRI (thoracic, abdomen), contrast CT scan (pelvis, abdomen), abdominal ultrasound, blood and urine, colonoscopy report. Every test came back negative and I was getting really frustrated. The doctors at the clinic performed the hooking maneuver, which caused a lot of pain on the right side, but almost none on the left side. My pain is just below the ribs, on the right side and it refers to the back. The pain is position based, more aggregated when sitting, almost pain free when in bed. There is a condition similar to costochondritis called slipping rib syndrome, which may be what I have. Currently, I am going for myofacial release massage and I would like to include the prolotherapy in my treatments. Some people have reported very good results in decreasing the pain. After 10 months of drug trials (meloxicam, neurontin, cipro), which did not help at all, 2 months of acupuncture and physio I am not very optimistic, that this will be fixed at all. And I used to be a competitive swimmer, also have a black belt in karate and used to run in marathons. Very sad!

Vlad
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Avatar_m_tn
Hello,

My current diagnosis is costochondritis with reffered pain in the upper right abdomen and low back. I have some slight pain in the lower ribs 11/12. It does not make much sense to me, since costochondritis is self-limiting and should disappear in 2-3 months.
There are other conditions though, which could make it chronic like seronegative spondylopathies. My pain is traveling thru the T10/T11 nerves, like a band.
The pain is burning with tingling and muscle twitching when worse after prolonged sitting. My family doctor is doing the following blood tests to check for any of the seronegative spondylopathies:

Erythrocyte sedimentation rate (ESR)
Immunoglobulins (Ig)
C-reactive protein (CRP)
rheumatoid factor (RF)
antinuclear antibodies (ANA)
human leukocyte antigen HLA-B27
Sacroiliac Joint X-Ray: Looking for abnormalities of the SI

Something else to consider is a MRI of the brain for MS, but with the Canadian health care system this is not going to happen soon. Good thing is, next month I will be in vacation in Europe, where I can pay and have the test on the day and bring the CD back.

I will keep you posted,

Vlad
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Avatar_m_tn
Hello,

I have just returned to Canada from a vacation in the country I was born (in Eastern Europe). I have spend two days in one of the best hospitals there, meeting 6-7 specialists and undergoing many additional test, trying to confirm the diagnosis of costochondritis or finding something else. I will not go into details, but very few people have been tested so extensively. The only test I have opted out was the diagnostic laparoscopy. I have spend a small fortune, but in Canada this would cost me a downpayment for a condo and take about a year.

The end result was: chronic insertionitis, or inflamation (inflammation) at the insertion of the internal
oblique muscles into the lower ribs. Prescribed therapy: anti-inflamatory  physiotherapy - ultrasound, magneto therapy; cortico-steroid shots, anti-inflammatory medications, etc.

Again, my symptoms are burning pain and feeling for pressure, just below the right ribs, which starts building when sitting for a long time (at least 1 hour). I have started
special exercises complex and Tai Chi each morning with 1 min cold water shower afterwards. This builds my energy level and gives me some temporary releif. There is no pain when sleeping.

I am about to start the physiotherapy, but first wanted to check if somebody else out there has this condition or knows how to treat this chronic insertionitis of the abdominal muscles.

Thanks,

Vlad
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Avatar_n_tn
wow. I can't believe I am reading this. I too feel your exact pain.Thanks to you I have somewhere new to start in self diagnosing myself. I just left my doctors office (for the 4th time) in FUMES!! after he asked me, "I'm not exactly sure what it is you want me to do for you I've run out of ideas." I am waiting for my MRI now but am really frustrated. Thank you for sharing all of your findings. I very much appreciated it.

Michel
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Avatar_m_tn
I'm 37yrs, 170cm and 83kg. I have exactly the same pain describe here for almost a year, but it radiates between left to right and build up with sitting or while driving.
I did bodybuilding in the past, before this problem I maintained a sport habit with a high protein input. I do office work for the last 5 years and suffered some pressures in life last 2 years..  

I did CT for the liver, lungs. Ultrasound for the abdomen, Endoscopy for the stomach, heart diagnosis .. . I was diagnosed with colon ulcer, after taking the treatment the symptoms still exist. The symptoms terribly intensity when getting emotionally angry and it feels like a belt tight around my lower ribs. There are more stomach gases since this problem started.

Recently I received injections for gallbladder inflammation/stones, but nothing changed.

I discovered that drinking more water and taking 1-2 Aspiring tables per day reduces the tension by 60-90%.

Much thanks for vnenov for sharing this information, hope vnenov  
can come back to tell us the what happened next.
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Avatar_m_tn
I'm 37yrs, 170cm and 83kg. I have exactly the same pain describe here for almost a year, but it radiates between left to right and build up with sitting or while driving.
I did bodybuilding in the past, before this problem I maintained a sport habit with a high protein input. I do office work for the last 5 years and suffered some pressures in life last 2 years..  

I did CT for the liver, lungs. Ultrasound for the abdomen, Endoscopy for the stomach, heart diagnosis .. . I was diagnosed with colon ulcer, after taking the treatment the symptoms still exist. The symptoms terribly intensity when getting emotionally angry and it feels like a belt tight around my lower ribs. There are more stomach gases since this problem started.

Recently I received injections for gallbladder inflammation/stones, but nothing changed.

I discovered that drinking more water and taking 1-2 Aspiring tablets per day reduce the tension by 60-90%.

Much thanks for vnenov for sharing this information, hope vnenov  
can come back to tell us the what happened next.
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Avatar_m_tn
Vlad, my husband has had the same pain and experience for the last seven years or so. He too, is a black belt in Karate. Has anyone mentioned whether or not Karate or exercising past "normal" physical limits has caused this? My husband is from Central Asia and his exercise regime is intense when he does Karate. Is the diagnosis still chronic insertionitis? Thanks.
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