I’m a 25 y/o female, 5′3 and 108 lbs. I’ve been experiencing right sided pain for about 6 months now. The pain is just under my right ribs and my 10th rib is actually extended a bit. The pain radiates to my back as well. I actually first noticed it about 9 months ago while doing aerobics. I’ve practiced the same aerobics routine for 2 years, so I’m unsure as to why the pain all of a sudden occurred during this particular session. I wasn’t doing anything strenuous or anything like that, but anway. I’m fairly athletic and exercise 4-5 days per week, or used to… I haven’t been able to since I’ve had this side pain… During the last 15 minutes of my aerobics class, I started noticing a sharp pain below my right ribcage. Since I only had 15 minutes left, I decided to keep going. As I kept moving, the pain increased a bit. After the class was over, the pain throbbed for about a day but went away. A few days later, I did an aerobics class and was fine. A few days after that, I performed the same aerobics routine and noticed the pain again. I worked through it and after the class, the pain throbbed for about a day or two but again, went away. I noticed it again about a week later while out dancing with friends. But, the pain subsided after the dancing. A few days later, I performed my normal aerobics routine, and again felt the pain, but continued with the class. This time, I took it really easy, but after the class was finished, the pain throbbed and felt really sore, and it never went away! This pain has stayed with me every single day for the last 6 months. It gets worse when I sit down. It’s no longer a sharp stabbing pain like when I felt when I was doing aerobics, 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, just above my hip bone but below my ribs. It’s like my whole right torso is affected! I also feel pressure sometimes underneath my right rib cage. I have a very hard time sitting at a desk, leaning forward to write, and 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. 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 5-10 minutes I start walking around a little bit and sitting down to eat my breakfast, it starts. It progesses 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 aggrivates it sometimes. Food doesn’t seem to make any difference. What I eat doesn’t bother it. Nobody can figure out what I have, but it seems to be getting worse. I’ve had many different types of blood tests, I’ve had a CT scan of my right side abdomen, and a CT scan of my pelvis, an MRI of my T spine and an MRI of my right abdomen and right ribs, a bone scan, 2 X RAYs of my ribs, an ultrasound of my right side, an ultrasound of my heart (echo) and everything has shown up normal. I’ve been checked for kidney stones, gall stones, kidney problems, liver problems (by blood test) gallbladder problems, but so far, everything is normal! I also went to an OB and he checked my ovaries and uterus and said everything feels normal. He also did a quick rectal exam, just by taking his finger and feeling around a bit and he said things feel normal. The doctors say that since everything has been ruled out, it’s most likely a musculoskeletal injury. The only thing I haven’t had done is anything stomach/intestinal related, but the doctors say that it’s most likely not needed since I’m having no trouble with food, digesting, or problems with my bowels. 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 accupunture and injury massage therapy with no luck. I am wondering if this is perhaps “slipped rib syndrome” also known as “costochondritis”. It sounds like that is what is is, please tell me what you think. If it is slipped rib, what can I do to heal this?

Dr. Joshua’s Answer:

It seems you have been very thoroughly examined. I’m happy that a thoracal spine MRI was also done to exclude thoracal disc herniation. One possibility that comes to mind is that you may have injured an intercostal nerve (between the ribs) during that fateful aerobics class. Consequently, neuropathic pain may have developed in the area of that nerve. I don’t know which medications have been tried, but you could talk to your doctor about trying medication for neuropathic pain, such as pregabalin (Lyrica). Other options include amitriptyline and carbamazepine. Please talk to your doctor about this, and of course this is just one possibility, and may not be the correct diagnosis, but seeing as your situation is difficult and you are running out of options, it may be worth a try. Costocohondritis is also a possibility, however chostochondritis usually resolves spontaneously in a matter of weeks so it does not seem an entirely satisfactory explanation for your symptoms. Good luck!