What is side pain?
Side pain occurs between the armpit and the hip.
Causes of Sharp, Stabbing Side Pain
Side Chest Pain
Pleuritic Chest Pain
Pleurisy (pleuritis) is an inflammation of the pleura–the double-layered membrane that covers the lungs.
- Symptoms: sharp, stabbing pain on one side of the chest, aggravated by deep breathing, coughing or moving the torso, shortness of breath (to avoid pain); sometimes pain in the shoulder, front of the chest or in the back, dry cough or fever
- Signs: crackling sounds during breathing detected by the stethoscope, slight chest wall tenderness
- References: (1,2,3,4)
- Cause: direct hit on the side of the chest
- Symptoms: dull pain on the side aggravated by moving the torso and arms
- Signs: moderate chest wall tenderness, a bruise
- The pain and bruise should reduce significantly within about 3 weeks.
- Reference: (11)
- Causes: fall from the height, direct hit, violent coughing, bending over a hard ridge
- Symptoms: sudden, severe pain on the side of the chest, aggravated by deep breathing, coughing, moving or bending
- Signs: a bruise, intense pain and cracking sound upon pressing over the broken rib
- Recovery time: about 6 weeks
- Reference: (10)
Serratus anterior is the muscle attached to the side of the ribs and the shoulder blade on each side of the body.
- Causes: muscle strain caused by repeated fast running, workout exercises, persistent coughing or lifting heavy objects with an extended arm
- Symptoms: moderate pain on the side of the chest below the armpit, below the shoulder blade and in the pinky side of the arm and hand; sharp pain can be triggered by deep breathing or coughing
- Signs: Pressing upon the trigger points at the level of 5th-7th rib on the side of the chest causes pain on the side of the chest and in the arm.
- References: (17,18)
Picture 1. Serratus anterior pain syndrome
Flanks are areas below the lower ribs on each side of the body.
- Causes: irritable bowel syndrome (IBS), constipation, lactose intolerance, fructose malabsorption, Crohn’s disease, ulcerative colitis
- Symptoms: pain after eating on the right or left side below the ribs or in the lower chest and in the shoulder tip (referred pain due to the irritation of the diaphragm), tenderness below the lower ribs and upper abdominal distension (bloating)
- Reference: (19)
Side stitch, “side cramp,” “runner’s stitch” or “exercise related transient abdominal pain” (ETAP) commonly occurs during running, swimming and horse riding.
- Symptoms: exercise-related, transient, moderate or severe, cramp-like or stabbing pain below the rib cage, more commonly on the right side and, sometimes, in the shoulder tip on the same side; pain is relieved within a minute of rest (11).
Stones in the ureter can cause constant or intermittent sharp pain in the right or left flank lasting for 20 minutes to several hours; pain can be extreme and can radiate into lower abdomen and groin; you may occasionally pass blood or a stone, but you typically have no fever (16).
Certain kidney conditions (infection, inflammation) can present with mild pain that can be made worse by slightly tapping over a kidney with a fist. Other symptoms may include nausea, fever, frequent urination and cloudy urine. In some kidney disorders, pain can be triggered by drinking large amounts of fluid, or severe dehydration.
Throbbing kidney pain can be associated with ureteropelvic junction obstruction, IgA nephropathy or Berger’s disease, or loin pain hematuria syndrome.
Kidney pain needs to be distinguished from other causes of lower back pain.
Adrenal Gland Pain
- Causes: adrenal tumor
- Symptoms: constant, dull pain in the flank, sometimes: fatigue, headache, excessive hair growth, weight gain, irregular periods, decreased libido, excessive thirst, frequent urination
- Reference: (23,24)
- Causes: liver inflammation (hepatitis), lymphoma, cancer
- Symptoms: constant fullness, discomfort or dull pain below the lower right ribs and, sometimes, anorexia, nausea and itchy skin
- Signs: Enlarged liver (hepatomegaly) can be palpated below the lower right ribs, sometimes jaundice.
- Reference: (22)
- Causes: gallstones, acute gallbladder inflammation (cholecystitis), biliary dyskinesia
- Symptoms: severe pain in the upper right abdomen or right middle back or shoulder blade, lasting from several minutes to several hours, nausea, vomiting
- Signs: Murphy’s sign (tenderness in the upper right abdomen)
- Splenic infarction (in leukemia, lymphoma, blood coagulation disorders, endocarditis, vasculitis) or splenic rupture (in blunt trauma).
- Symptoms: sudden, severe pain on the left side under the lower ribs and, sometimes, in the left shoulder tip; fever, chills, nausea, vomiting (5)
- Signs: tenderness over the left lower ribs on the side; in internal bleeding: rapid heartbeat and breathing, anxiety, pale skin
- Enlarged spleen (splenomegaly), for example, in infectious mononucleosis (Epstein-Barr Virus infection), malaria, liver cirrhosis, leukemia, lymphoma, sarcoidosis, hereditary anemias (sickle cell disease, spherocytosis)
- Symptoms: constant fullness or mild, dull pain on the left side under the lower ribs, recurrent infections, paleness and weakness due to anemia
- Signs: a large, soft lump below the rib cage on the left side
- Reference: (7)
- Cause: reactivation of a childhood Herpes zoster virus infection in one or more spinal nerves, usually only on one side, more commonly in older adults
- Symptoms: moderate side pain, tenderness, tingling or numbness followed–after several days–by a red, itchy, burning rash that travels as a horizontal stripe from the spine around the torso, which eventually crusts over and heals on its own in few weeks without leaving scars.
- Reference: (8)
Pinched Spinal Nerve
- Cause: a bulging or herniated disc in the thoracic or lumbar spine, arthritis, nerve injury during rib fracture or kidney surgery
- Symptoms: recurring stabbing pain, tingling or numbness on one side of the back and chest aggravated by moving the torso (11)
Adhesions are bands of an abnormal fibrous tissue (scars) in the abdominal or pelvic cavity.
- Causes: retroperitoneal fibrosis, surgery, appendicitis, cholecystitis, peritonitis, radiation therapy
- Symptoms: chronic moderate or severe pain in various parts of the abdomen or pelvis
- Reference: (20)
Abdominal Aortic Aneurysm
The pain from an abdominal aortic aneurysm may mimic the pain from urinary stones (renal colic) (11).
Lower Side Abdominal Pain
Myofascial Pain in Latissimus Dorsi Muscle
- Causes: muscle overuse due to rock climbing, gymnastics, strength training, ball games
- Symptoms: pain above the hip, below the shoulder blade, in front of the shoulder and in the pinky side of the arm and hand
- Signs: pain triggered by pressing near the lower shoulder blade angle (9).
Diverticulitis is an inflammation of pouches that form in the large intestine.
- Symptoms: constant pain and tenderness in the lower left abdomen, fever, nausea, constipation or diarrhea, occasional blood in the stool (14)
- Symptoms: vague, constant pain around the belly button, which within few hours moves to the lower right abdomen, becomes severe and is aggravated by moving and coughing; other common symptoms: nausea, vomiting, fever
- Tenderness in the lower right abdominal quadrant
- Rebound tenderness: applying pressure upon the left lower abdomen and quickly releasing it triggers pain in the right lower abdomen.
- Reference: (21)
Lower Side Abdominal Pain in WOMEN
Ovulation pain occurs in the middle of the menstrual cycle (about 14 days before period) on the inside of the hip on either side, it can be severe and can last from few minutes to 48 hours (15); if it lasts longer, it could be associated with endometriosis or other disorder.
Other causes of ovary pain: ovarian cyst rupture, cancer (late stage).
Round Ligament Pain During Pregnancy
- Symptoms: shooting or crampy pain near the hip or in the groin, more commonly on the right side; the pain can occur from early pregnancy on (25).
- Symptoms: sudden, sharp or slowly developing pain on one side of the lower abdomen and, sometimes, vaginal bleeding and pain in the shoulder tip on the same side (13).
Other Causes of Side Pain in Women
- Pelvic inflammatory disease
- Pleurisy NHS Choices
- Pleurisy Causes NHS Choices
- Pleuritic Chest Pain FPNotebook
- McCoy K, 2008, Acute Silicosis Beth Israel Deaconess Medical Center
- Splenic Infarct Emedicine
- Splenic Rupture Emedicine
- Splenomegaly The Merck Manual, Professional Edition
- NINDS Shingles Information Page National Institute of Neurological Disorders and Stroke
- Latissimus Dorsi Muscle Pain And Trigger Points Painotopia
- Rib fracture, clinical presentation Emedicine
- Muir B, 2009, Exercise related transient abdominal pain: a case report and review of the literature PubMed Central
- Morton DP, 2003, Exercise related transient abdominal pain PubMed Central
- Ectopic Pregnancy Patient.info
- Diverticula (including Diverticulosis, Diverticular Disease and Diverticulitis) Patient.info
- Ovulation Pain Better Health
- Causes of Flank Pain Emedicine
- Serratus Anterior Muscle Syndrome ExpertConsult
- Serratus anterior stretch Pressurepointer.com
- Gas in the Digestive Tract John Hopkins Medicine
- Adhesions, General and After Surgery WebMD
- Appendicitis Patient.info
- Enlarged Liver Symptoms Mayo Clinic
- Diseases of the Adrenal Cortex: Adrenal Cancer Endocrinoweb
- Cushing syndrome due to adrenal tumor MedlinePlus
- Murry MM, Round ligament pain: Understanding this pregnancy complaint Mayo Clinic