📌 Table of Contents
- Stop 1 — The Urologist: Ruling Out Kidney Stones
- Stop 2 — The Internist and the MRI: An Unexpected Finding
- All the Tests at a Glance
- Stop 3 — The Orthopedic Surgeon: Finally, an Answer
- FAQ: The Questions I Kept Googling at 2 AM
At first, I was convinced I'd simply pulled a muscle. I'd been spending long hours at my desk, and I'd done a little lifting around the house the previous weekend. Nothing about the pain felt urgent, so I kept telling myself it would disappear on its own. Looking back, that assumption probably delayed my diagnosis by a couple of weeks.
It started as a twinge. Not alarming, just noticeable — a sharp, intermittent pulling sensation along my left side, somewhere under the ribs, that came and went without any obvious trigger. I ignored it for about a week, the way many people do when they're in their 50s and used to blaming aches and pains on getting older.
Then it became two weeks. Then three. The pain wasn't getting dramatically worse, but it wasn't improving either. I caught myself moving differently without even realizing it, hesitating before twisting or reaching because I expected that familiar sharp pull.
Over the next two days I ended up seeing three different specialists — a urologist, an internist, and finally an orthopedic surgeon. Each visit ruled out another possibility until one doctor finally explained what was really happening. Looking back, the journey itself taught me almost as much as the diagnosis.
Stop 1 — The Urologist: Ruling Out Kidney Stones
The first thing that crosses anyone's mind with sharp left flank pain is kidney stones. I'd heard enough horror stories from friends to know that the pain from a stone can be severe enough to send people to the emergency room, and the left side — just below and behind the lower ribs — is exactly where kidney pain tends to show up. Starting with a urologist felt like the right call.
What the Urologist Tested
The workup was thorough and moved quickly. First, a urinalysis — a urine sample examined under a microscope to check for traces of blood. Kidney stones frequently cause microscopic bleeding even before any visible blood appears in the urine, and that hematuria is one of the earliest and most reliable indicators that something is going on in the kidney or ureter. My urine came back clean — no blood, no signs of infection.
Next, a kidney and bladder ultrasound. The primary thing an ultrasound is looking for in this context is hydronephrosis — the swelling that happens when a stone obstructs the ureter and backs urine up into the kidney. A blocked kidney swells visibly on ultrasound, and it's a finding that changes the management urgency considerably. My kidneys looked normal. No swelling, no structural abnormalities, no stones visible in the kidneys or bladder. The urologist also ordered a plain abdominal X-ray — specifically to look for calcified stones that would show up as a dense shadow along the course of the ureter. Nothing there either.
The conclusion was unambiguous: "Your kidneys and bladder are completely normal." Kidney stones were off the table entirely.
💡 Practical tip if you're heading to the urologist for this kind of evaluation:
Try to arrive with a reasonably full bladder — don't use the bathroom right before you go in. The ultrasound assessment of the bladder and the urine test are both more informative when the bladder actually has something in it. It's one of those small logistical details that can meaningfully affect the quality of what the imaging shows.
Why Starting With Urology Was the Right Call
Even though the urologist found nothing, starting there was medically correct. Kidney stones and acute kidney obstruction are the kind of diagnoses that need to be ruled out early, because if a stone is causing a significant blockage, the window for non-invasive management narrows quickly. Getting a clean bill of health from the urologist didn't resolve my pain, but it ruled out the most urgently serious possibilities and let the next step of the investigation proceed with a different set of questions.
Stop 2 — The Internist and the MRI: An Unexpected Finding
With kidney stones eliminated, the next concern shifted to the internal organs — specifically the pancreas, gallbladder, and large intestine, all of which sit in the upper and middle abdomen and can refer pain to the left flank. In men in their 50s, this list carries more weight than it might have a decade earlier — cancer rates in digestive organs increase meaningfully in this age bracket, and the anxiety of "what if it's something serious" was sitting quietly in the background of the whole process.
Why an MRI Rather Than a Standard Ultrasound
After kidney stones had been ruled out, the focus shifted to the organs inside my abdomen. My doctor explained that while an ultrasound is useful for many conditions, it doesn't always provide a clear view of the pancreas because bowel gas can block the image. Since my pain was persistent and located on the left side, he recommended an abdominal MRI for a more complete evaluation.
Along with the MRI, I also had routine blood work, including liver function tests and an inflammatory marker (CRP). The goal wasn't simply to find a diagnosis—it was to systematically rule out problems involving the pancreas, liver, gallbladder, and other abdominal organs before considering a musculoskeletal cause.
The Unexpected Finding: Two Gallstones
The MRI was reassuring in one sense. There were no tumors, no signs of pancreatitis, and nothing that explained the pain on my left side. But there was one unexpected finding—two small gallstones.
My first thought was, "So that's the problem." My doctor smiled and immediately explained why it probably wasn't. Gallstones usually cause pain in the upper right abdomen, often after eating fatty foods, because that's when the gallbladder contracts. My pain stayed on the left side and wasn't related to meals, so the two simply didn't match.
In the end, the gallstones became an incidental finding rather than the answer. They're something I'll continue to monitor, but they weren't responsible for the symptoms that brought me to the clinic.
💡 If you're scheduled for an abdominal MRI or ultrasound:
Fast for at least 8 hours beforehand — no food, no coffee, ideally nothing but small sips of water. When you eat, the gallbladder contracts and the stomach fills with gas, both of which degrade image quality significantly and make it harder to assess the structures clearly. An 8-hour fast before abdominal imaging is standard for a reason.
All the Tests at a Glance
After two days and three specialty clinics, here's the complete picture of what was tested, how, and what each evaluation showed.
| Specialty | Tests Performed | Finding |
|---|---|---|
| Urology | Urinalysis (microscopy for blood and infection), kidney and bladder ultrasound, plain abdominal X-ray (KUB) | All normal — no stones, no kidney swelling, no urinary infection |
| Internal Medicine | Abdominal MRI (liver, gallbladder, pancreas, spleen), liver enzyme blood panel, inflammatory marker (CRP) | Two small gallstones in the gallbladder — incidental finding, not the cause of left-sided pain. All other organs normal. |
| Orthopedic Surgery | Manual palpation of rib margins and thoracic spine, thoracic X-ray, posture-provoked pain assessment | Intercostal neuralgia and external oblique muscle spasm — confirmed as the actual source of pain |
Stop 3 — The Orthopedic Surgeon: Finally, an Answer
With internal organ causes eliminated, the orthopedic surgeon's evaluation felt like the final piece of the puzzle — or at least, the place where a musculoskeletal cause would finally get a proper look. I walked in half-expecting to be told my pain was "non-specific" and to come back if it got worse. What I got instead was an actual diagnosis within about fifteen minutes of the physical examination.
What Intercostal Neuralgia Actually Is
The diagnosis was intercostal neuralgia — irritation or compression of one of the small nerves that run between the ribs. To understand why this produces the specific kind of pain I'd been experiencing, it helps to know a little about what these nerves do.
Between each pair of ribs runs a small intercostal nerve that supplies sensation to a strip of the skin and muscle along that part of the chest and abdomen. These nerves can be compressed or irritated at any point along their course — sometimes by muscle tension in the muscles that attach to the ribs, sometimes by subtle changes in the thoracic spine, sometimes by inflammation at the point where they exit the spine. When they're irritated, the pain they produce has a characteristic quality: it's sharp and electric rather than dull and achy, it tends to follow a relatively linear path along the rib, and it worsens with deep breathing or twisting the trunk, because those movements stretch the tissues around the nerve.
In men in their 50s, intercostal neuralgia becomes more common for a specific reason: thoracic spine flexibility decreases with age, and the external oblique muscles — the large muscles that cover the sides of the abdomen — are particularly prone to tightening and developing trigger points in sedentary or desk-bound individuals. When these muscles are chronically tense, they can press directly on the intercostal nerves running just above them. The result is exactly the intermittent, sharp, location-specific pain that I'd been trying to explain for three weeks.
The Three-Step Treatment That Resolved It
The treatment was staged, and each stage addressed a different part of the problem.
The first step was a nerve block injection — a targeted injection of an anti-inflammatory and local anesthetic directly at the point where the nerve was most irritated, guided by imaging to make sure it hit the right spot. The relief was immediate and dramatic. Within an hour of the injection, about 70% of the pain had simply gone. That response itself was diagnostically informative — it confirmed that the nerve was genuinely the source of the pain, rather than referred pain from somewhere else.
The second step was a combination of extracorporeal shockwave therapy — a device that delivers high-energy sound waves into the tightened muscle tissue, breaking up adhesions and stimulating blood flow to promote healing — and manual physical therapy, where a physiotherapist worked on realigning the thoracic spine and mobilizing the ribs. This addressed the mechanical cause rather than just the nerve irritation itself.
The third step was a short course of medications: a nerve pain agent (gabapentin class) to quiet the remaining neural irritability, a muscle relaxant to release the persistent tension in the external oblique, and an anti-inflammatory to manage residual swelling. Five days of medication, combined with the injection and physical therapy, and the pain that had been present every day for three weeks was effectively gone.
What surprised me most wasn't how quickly the pain improved—it was how quickly I stopped thinking about it. For weeks, I'd automatically protected my left side whenever I turned in bed, reached for something on a shelf, or got out of the car. A few days after treatment, I realized I was moving normally again without expecting that sharp twinge. That quiet moment was when I knew we had finally found the real cause.
💡 Simple stretch to prevent recurrence:
Clasp your hands above your head and slowly lean to each side, holding the stretch for about 20–30 seconds on each side. Done morning and evening for 3 minutes, this keeps the muscles along the ribcage from shortening and compressing the intercostal nerves — which is exactly what allowed the problem to develop in the first place. It takes almost no time and costs nothing.
FAQ: The Questions I Kept Googling at 2 AM
How do you tell the difference between muscle pain and a kidney stone?
This is genuinely the most useful diagnostic question, because the two can feel similar in terms of location — both can produce sharp pain in the flank area, and both can come and go rather than being constant. The key differentiator is how the pain responds to position and movement. Muscle pain and intercostal nerve pain are typically worsened by specific movements — bending, twisting, deep breathing, or pressing on the tender area. Kidney stone pain typically doesn't change with position at all. It tends to be colicky — coming in waves of severe, cramping intensity — and it's often accompanied by nausea, vomiting, or blood in the urine. If the pain is position-sensitive, the muscle and nerve system is more likely. If changing position does nothing, the urinary tract deserves a look.
Should I go to an orthopedic surgeon first, or start with urology?
The medically safer sequence is to start by ruling out internal organ causes — specifically the kidneys and the digestive organs — before attributing the pain to muscles or nerves. This is because acute kidney obstruction, pancreatic inflammation, and certain abdominal emergencies can present with flank pain that feels musculoskeletal, and some of these require urgent management. Once a urologist and general internist have cleared the internal organs, an orthopedic evaluation becomes the appropriate next step. Going directly to orthopedics first, while tempting if the pain feels muscular, risks missing something that needs faster attention.
The MRI found gallstones I didn't know about. Do I need surgery?
Not necessarily, and probably not right away if they're small and not causing symptoms. Asymptomatic gallstones — meaning stones that are simply sitting in the gallbladder without causing pain or inflammation — are typically managed with watchful waiting rather than immediate surgery. The recommendation I received was an abdominal ultrasound every six months to a year to check that the stones aren't growing or causing gallbladder wall changes. Where it gets important to pay attention is if you start experiencing pain in the upper right abdomen or just below the breastbone after eating, particularly after fatty meals — that pattern of symptoms suggests the gallstones are becoming symptomatic and causing intermittent bile duct obstruction, which should prompt a conversation with a gastroenterologist about whether surgical removal makes sense.
Could this be shingles instead of intercostal neuralgia?
Yes, and this is worth knowing about. Shingles (herpes zoster) reactivates along nerve pathways, and one of the most common sites is the thoracic dermatomes — the same nerve distribution that produces intercostal neuralgia. In its earliest phase, before any skin changes appear, shingles can produce exactly the kind of sharp, burning, or electric pain along one side of the trunk that I was experiencing. The distinguishing feature typically arrives within three to four days of the pain onset: a rash of small fluid-filled blisters in a band-like distribution along the affected nerve's territory. If you're experiencing unilateral flank or trunk pain and a rash appears in the area within the first several days, go to a doctor or dermatologist the same day — antiviral medication is significantly more effective the earlier it's started after the rash appears. If no rash develops after four or five days, shingles becomes much less likely, but it's worth having a clinician assess the pattern.
What I Took Away From Two Days and Three Doctors
📢 Persistent flank pain deserves an explanation — not indefinite waiting.
Looking back at the three weeks I spent trying to wait the pain out, the thing that strikes me is how reasonable it felt in the moment to keep putting off doing anything about it. It wasn't debilitating. It came and went. There was always a plausible innocent explanation — bad posture, sleeping funny, sitting too long. The way I rationalized it is probably familiar to a lot of men my age.
What the experience actually showed me is that persistent, location-specific pain in the flank — especially pain that lasts more than two weeks and changes how you move — almost always has a specific mechanical or structural cause. And that cause is almost always identifiable through a logical sequence of evaluations. The sequence doesn't need to be rushed or panicked. But it does need to happen, because the longer you wait, the longer you're in pain that could have been resolved.
The incidental gallstone finding was its own reminder of that principle. Two gallstones, sitting quietly in my gallbladder, that I had no idea were there. Not causing my flank pain. Not requiring surgery right now. But worth knowing about, worth monitoring, and now actually on my radar instead of being invisible. That's the kind of information that only surfaces when you actually go and get things checked — and it's genuinely useful to have.
If you've been sitting with a persistent left-sided ache, telling yourself it'll probably clear up — consider starting with a urologist. Get the kidney question answered first. Then go from there. The path from "I don't know what this is" to "I know exactly what this is and here's how we fix it" turned out to be two days and three appointments. That's manageable.
Medical References
- Mayo Clinic – Gallstones
- Cleveland Clinic – Intercostal Neuralgia
- Johns Hopkins Medicine – Kidney Stones
- MedlinePlus – MRI
- NHS – Shingles
⚠️ This post is a personal account of one individual's diagnostic experience and is intended for general informational purposes only. Left-sided flank pain can have many causes, including some that require urgent evaluation — aortic aneurysm, splenic pathology, acute pancreatitis, and early-stage shingles among them. If your pain is severe, sudden in onset, accompanied by fever or vomiting, or worsening rapidly, seek medical attention promptly rather than following a non-urgent referral pathway. Always consult a qualified physician for symptoms that concern you.