what can cause tightness sensation under 12th rib in the kidney area

[ThutmoseChen]

I have this long-term symptom that makes speaking difficult, it probably sounds bizzare to many health professionals as they keep refering me to respiratory system specialists who end up finding nothing. I, on the other hand can feel that the sensation of something being tight and resisting against my rib came from inside the tip of 12th rib, exactly where the left kidney is. It is really strange how this tightness sensation contributes so much to issues with speech. Imaging tests also show that kidney itself is functioning normally, but it feels as though its tightly pressed against the rib so any rib movement feels resisted and restricted. Some local doctors brush it off as muscle spasm, but it has been going on for many years so there`s basically no chance its muscle related.

[Ken_PA]

This just popped up on my youtube suggestions. If you watch just a minute or two you can get a much better idea of what a 12th rib looks like in size and shape, more than just from drawings, as it gets handled and turned every way.

https://www.youtube.com/watch?v=pv7nDQ3jvLU

[Ken_PA]

I'd regard resection as the radical last resort.

What to try first? Anything that's:
- not dangerous
- not too expensive
- not too difficult

Such approaches you can try even if there's not a big chance of success.


Look into Alpha Lipoic Acid as a possible way to sort of calm the T12 nerve. Plus whatever is generally taken along with the ALA.

Topical anti-inflammatories like capsaicin and menthol. They might not penetrate deep enough, but are worth a try. Topical aspirin, too, just to see what happens. If any of those work, those are clues to tell to a doc. A doc might even try a shot of cortisone, though not as a cure.

12th rib syndrome is heterogenous, so every clue helps.

Maybe try some sort of manipulation therapist. Some might be wacky, but it's a long shot that might help for you.

I'd become expert in the pathophysiology (the mechanism of how the bad happens). Then you might think of how to interfere in that mechanism. Though maybe it's as simple as pressing or rubbing because of your individual anatomy.

You can ask for a 'review' of any scans you've had to specifically look for 12th rib syndrome. Your scans prbly would have seen any benign masses such as hemangioma, so that'd be ruled out.

Which doctor? I just looked up for you the doc in that lecture video. He's an Internist. I'd look up every paper on Pubmed for this condition, and see what kind of doc the authors are.

I'd generally seek a Functional Medicine type of Internist since their approach is to look for the cause of problems. Regular docs just do pattern matching, which works in regular cases but hasn't helped you.

I don't know if you've had Nerve Conduction Studies, that'd likely be a neurologist for that specifically.

Now I hate to recommend Facebook to anybody, but I did see somewhere that there might be a FB group on this. I'd be wary of their advice, but somebody might recommend a knowledgeable doc in your area.

[Ken_PA]

Well TC, that's why I made a point to say that you don't have to have severe pain - your sensation can likewise be from a sensory nerve while falling short of being actual pain. They are both sensory neuropathy. That's why I also said it is important to understand the idea of "atypical" cases (of any medical condition).  

"I wonder if motor nerve dysfunction you mentioned might be the cause after all."
Most or all of the 13th rib cases might not have motor nerve involvement; that doesn't mean you as an individual cannot have motor nerve involvement which impairs intercostal muscle function, which can in turn create what you describe as impaired ability on exhalation. Which in turn can be impairing speech.

This whole 12th rib syndrome is not settled science; it is not well known and so as you read more and more, you'll find contradictions.

You'll also encounter "the cause is not well known" or "the mechanism is not well known".

All that together means you should learn as much as possible about the how and why - rather than being merely content with whatever categories and narrow lists of symptoms are currently existing.

A doc might say to you, "you don't have severe pain so forget this". Then tomorrow a study might be published that says "you don't have to have severe pain". Get it? It's not settled.

Also, let's face it: if a patient doesn't have severe pain they likely won't go to a doctor anyway. So most or all of the cases actually seen by doctors are only in the severe pain category. It's logical. That also fits with you saying: "Honestly if it weren`t for the awful speech issue it cause me I wouldn`t even notice the existence of this sensation."

You can find and master everything there is about that "hooking maneuver" test, then get somebody you know to do it on you.

You can research what the treatment is and try what you can on your own.

You can learn as much as possible and intelligently present the facts with *authoritative* sources to an open minded doc, such as a good Functional Medicine Internist.

[ThutmoseChen]

Thanks again. I read that in the treatment of the  12th rib syndrome resection of the 12th rib is used to provide long-lasting reliefs. Now, whether my issue can be diagnosed as 12th rib syndrome or not, I`m sure a rib resection can resolve it. Problem is probably no surgeon would offer it to me without a clear diagnosis and okay from a specialist. I feel like I see the resolution but cannot see how to make my way there given that most providers don`t really understand what I`ve been going through.

[Ken_PA]

Here's the short answer: you probably have "twelfth rib syndrome", with additional atypical motor nerve involvement.

[Ken_PA]

Hi, Thutmose. It seems to me that you luckily have a very clear path ahead for you. You should become expert in your own condition, since the standard approach of seeing specialists for years has gotten you nowhere.

Luckily, all the relevant info is waiting for you to discover it. The most difficult hurdles for you will be in learning all the medical terms, like "clinical diagnosis", "diagnosis of exclusion", "intercostal" -- and even **floating** rib, which is very relevant. Also: motor versus sensory nerves. And "referred pain".

You'll also want to completely understand "atypical case". We want to tie in dysfunction of the intercostal muscles and speech.

So here we start with a lecture video.
"Twelfth Rib Syndrome"
https://www.youtube.com/watch?v=WF9XaxyK6i0

Watch that at least three times. Even though you are very methodical, no one can absorb it all in one attempt. Notice that it's also called "rib tip syndrome".

Then go to Pubmed. You wanted people who are like you? This is one "case report". You don't have to match exactly - you have a sensation, not severe pain. But find as many cases as you can. Amass knowledge.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7479855/

Notice there is a physical test called "hooking maneuver". Note these words: "Although twelfth rib syndrome seems to be quite common, it is often overlooked and takes a long time to diagnose."

Good luck.

Btw, what you have is not psychosomatic. But possible perfectionism and anxiety might make things worse.

An MRI can see nerve inflammation better than a CT. You don't need to have physical/impact damage to have nerve dysfunction.

[ThutmoseChen]

Wow thanks for the great answer. I am looking into 12th rib syndrome right now, most cases seem to involve a lot of loin pain. I donot feel any pain at all, it is just this weird tightness, fullness sensation coming from inside of the rib. Honestly if it weren`t for the awful speech issue it cause me I wouldn`t even notice the existence of this sensation. But this feeling under the rib eventually translate into the feeling of "something is stuck/squeezed" whenever I try to speak, it is so bizzare. I wonder if motor nerve dysfunction you mentioned might be the cause after all.

[AnnieBrooke]

Have you seen a neurologist? Issues with the vagas nerve can cause problems with speaking, plus it is a long nerve that goes all the way down to part of the colon. (When I had vagas nerve problems it manifested as chest pain.)

[ThutmoseChen]

Thank you for the reply! My neurologist said its impossible for me to have nerve damage because I have no history of injury at all. I did not know about the vagus nerve though, from what I read upon in the past 10 minutes, the speaking issues caused by vagus nerve damage appear to be hoarseness, and it doesn`t really fit my symptoms. But I will talk to a neurologist about this possibility nonetheless!

In the past my symptoms were so bad that I struggled so much with speech, these days its been drastically better since I corrected some of my spinal posture issues. That is also why I feel the pressure/tightness under 12th rib is very physical rather than neurological, as it gets drastically lighter with the change of my rib cage positioning. However it seems no one else can relate to how I feel.