Twelfth rib syndrome- an often missed differential diagnosis of hypogastric and lumbar pain: case series

Sangeeeta Arya, Anil Kumar Verma, Bikram Kumar Gupta, Mohd. Hifzur, Sachidanand Gupta, Neetu Singh


The twelfth rib syndrome appears to be a fairly common and underdiagnosed chronic pain syndrome. The diagnosis of this syndrome is clinical, requires exclusion of specific etiologies, and should only be made when the patient's symptoms can be exactly reproduced by manipulation of the affected rib.  Patients with this syndrome can be over investigated and have even undergone surgical procedures when this diagnosis has been overlooked. We present here a case series of 27 women of twelfth rib syndrome over a period span of 18 months, many of whom had come to us after having prolonged and ineffective treatment for lumbar or hypogastric pain. Such patients were successfully managed with infiltration of local anaesthetics and steroid.


Twelfth rib syndrome, Lower abdominal pain, Conservative management, Local anaesthetics

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