Loin pain

A 47-year-old woman was hospitalized for loin pain and consulted with the pain clinic because the cause of the pain had not been found despite various tests. She had a 3-month history of intermittent pain in the loin and both lower rib cages. The pain was sharp and intermittent and was aggravated by walking. Her numeric rating scale score for pain was 8. She had no history of trauma or injury. All radiological findings were normal, including an abdominal CT scan, bone scan, and X-rays of the rib cage. Physical examination revealed severe tenderness in the subcostal area that was reproduced by the hooking maneuver.