a common and underdiagnosed chronically painful disorder about the loins. It is more common in women than men (3:1 predilection) and is usually described as a constant dull ache or sharp stabbing pain that may last from several hours to many weeks. 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. It is thought to occur due to inflammation of the 12th intercostal nerve.