How does rib pathology cause flank pain?

Updated: Dec 11, 2019
  • Author: Bradley C Gill, MD, MS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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A fractured or injured 11th or 12th rib can cause flank pain with anterior and inferior radiation similar to the pain distribution of renal colic. While this is usually from trauma, sometimes prolonged violent coughing can cause the injury. Displacement of the fractured rib is rare. Renal injury from the fracture is uncommon but possible in the setting of significant trauma. 

Direct palpation of the involved rib usually produces intense pain. Deep respiration is also painful.

Vitamin D deficiency was the reported cause of flank pain in 187 patients with distinct tenderness over the tips of the lowermost ribs that could not be explained by history and radiology. Very low serum levels of 25 (OH) vitamin D was detected in all of the cases. Relief of flank pain was reported within 2 months in 55.1% of patients treated for vitamin D deficiency. [1]

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