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38yo female with 4 year history of intermittent, sharp, LUQ pain with lumbar flexion. No history of trauma/injury. Pain does not occur all the time with the same maneuvers, but when it occurs, it is quite severe. When she assumes an upright posture, the pain resolves within 45 seconds. She describes a "catching" sensation when the pain occurs. She has seen multiple physicians over the years, and has had numerous xrays, CTs & MRI. No abnormality detected. Has tried NSAIDs without any benefit. She actually feels somewhat sheepish about even seeking medical attention because she notes that the pain does not always occur, is short-lasting when it occurs and it doesn't really limit what she does. However, she has an 18 month old child and occasionally when she bends over to pick up her child, the pain does strike and she doesn't want to drop her child due to the acute onset of the pain.
No pain with respirations, rib/costchondral palp, etc. She is thin, fit and exercises regularly. (Pain will occasionally occur with crunches). Only physical finding was a 1cm area of exquisite tenderness at the left superiolateral border of the rectus muscle. I injected local into this area and asked her to flex, etc., to try to produce the pain. She noted it felt like the "pain was going to start" but it did not. However, the pain is not consistently reproducible with activity.
any ideas? thanks
No pain with respirations, rib/costchondral palp, etc. She is thin, fit and exercises regularly. (Pain will occasionally occur with crunches). Only physical finding was a 1cm area of exquisite tenderness at the left superiolateral border of the rectus muscle. I injected local into this area and asked her to flex, etc., to try to produce the pain. She noted it felt like the "pain was going to start" but it did not. However, the pain is not consistently reproducible with activity.
any ideas? thanks
