Jacobs, Monica L Y E et al.
Ultrasound-guided abdominal wall infiltration versus freehand technique in anterior cutaneous nerve entrapment syndrome (ACNES): randomized clinical trial.
BJS open vol. 5,6 (2021):zrab124.
- Predictable site of abdominal tenderness with a small (< 2 cm) area of maximal intensity (the TP) situated within the lateral boundaries of the rectus abdominis muscle
- The presence of somatosensory skin disturbances such as altered cool sensation, hypoaesthesia, or hyperaesthesia covering the TP
- Intense pain while squeezing the abdominal wall skin covering the TP (pinch test)
- Tenderness increased by abdominal muscle tensing using Carnett’s test
Trigger injection – site marked and “the needle was inserted at the TP and penetrated the anterior sheath as subjectively experienced by a characteristic ‘plop’. If attempted aspiration of the plunger did not yield blood, 8–10 ml of 1 per cent lidocaine was injected.
Comments – I’m glad ultrasound failed to improve results as much more expensive for patients. It should be noted that injections only worked 30+ % in longterm and so better ways of dealing with it are necessary. Had one case that failed to respond to shots of steroid or alcohol but did well with botulinum injections followed by alcohol blocks. She was also found to have an L3 disc protrusion for which she could have had an epidural but it was not necessary
Self Massage – a technique I use for irritable bowel is to engage tissues laterally with fingers and push medially slowly though tissues – could be very painful but over 10-15 minutes might release. Then engage tissues medially with bad side down and try to work it – it will be much more painful that way. After, you can run your knuckles over tissues and see if you can get more releases.