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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 34279
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I am having some tenderness/fullness on my left side, on or

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I am having some tenderness/fullness on my left side, on or under my rib cage towards the back. I had this checked by a doctor a few weeks ago and they suggested that this was the kidney area. They did an ultrasound and found nothing. I was recovering from a bought of bronchitis and they thought it could be rib tenderness from coughing. Now several weeks later, and long after I've stopped coughing, it's recurring. I can't tell if it is the ribs, or underneath. It's honestly not even painful enough for meds but it's clearly not normal. When I press on light pressure, it seems to ease. Any thoughts on what this could be?

A mild nagging tenderness / fullness (and ultrasound being normal) is likely to be myofascial pain syndrome. These are hyperirritable tender spots in palpable tense bands of skeletal muscle. Trigger points may develop after an initial injury to muscle fibers. This injury may be a noticeable traumatic event or repetitive microtrauma to the muscles (like cough for some duration). The trigger point causes pain and stress in the muscle or muscle fiber. Unless this is treated actively, this may persist for long time. The treatment is following;


1) passive stretching of the affected muscle after application of sprayed vapocoolant.

2) physical therapy; simple muscle stretch, augmented muscle stretch, post-isometric relaxation.

3) deep electrotherapy; iontophoresis, phonophoresis, short wave diathermy, electrical stimulation, high voltage galvanic stimulation, biofeedback.

4) local analgesic patch / ointment / spray

5) anti-inflammatory analgesics; Ibuprofen (Motrin / Advil)

6) ischemic compression therapy; pressure on the points

7) massage

8) steroid shots

9) acupuncture


The other possibility is Costochondritis; it is inflammation at the junctions of rib and cartilage. Local analgesic ointment, or spray, chest brace and warm compresses with Ibuprofen is helpful. Another possibility is muscle sprain. Please read about the costochondritis;


Please feel free for your follow up questions.


I would be happy to assist you further, if you need any more information.


Dr. Arun
Customer: replied 5 years ago.
I just looked at the link you sent for Costochondritis and it sounds as if this is generally towards the sternum? My tenderness is towards the side/back of my ribs, so that doesn't sound like it unless I'm understanding it incorrectly.

The myofascial pain syndrome sounds possible. Can you tell me if this might tend to come and go a bit? I did have an allergy attack last week for several days (the pollen here in Virginia is outrageous) and had some coughing, though much less severe than the bronchitis I mentioned earlier, as well as a lot of vigorous nose blowing. Might what you are explaining make sense to recur after something like that?

Also, the myofascial pain syndrome - would that be localized to an injury/"traumatized" area? I've had a few other very specific areas of joint pain recently which are quite new to me - not something I've ever experienced before - one is the middle joint of the middle fingers on my right hand and the other is my left elbow.

I suppose I'm trying to determine if the kidney area pain is musco-skeletal, versus a kidney issue. And if it's not the kidney, whether something is going on such that these other mild joint pains are related or just coincidence.

Would you suggest that I try some of the treatments you suggested for the rib symptoms to see if that is alleviated first?

Costochondritis can be in front (joint of breast bone and cartilage) or on the sides too (joint of rib and cartilage). But if the pain is on the back; this is not much likely.

The myofascial pain can vary in the pain intensity and thus can come and go a bit. It seems it was healing in your case initially. Than it was aggravated, by nose blowing and recurrence of coughing. Myofascial pain usually occur on trunk, back or where there is a thick pad of muscles like limbs.

Your elbow pain and middle finger pain is not likely to be related to kidney area pain. Elbow area pain can be tennis elbow / golfer elbow. The kidney area pain is likely to be musculoskeletal because;

1) Your ultrasound was normal.
2) A tender kidney would most of the time will have fever (kidney infection), significant / severe pain (stones) and urinary symptoms (pyelonephritis, hydronephrosis etc).

I would recommend the treatment we discussed under the myofascial pain.

It is privilege assisting you.

Dr. Arun
Dr. Arun Phophalia and 2 other Health Specialists are ready to help you
Customer: replied 5 years ago.
Thanks very much!
You are very welcome.

Good luck.