Disclosures: Nathan B. Darji, DO: No financial relationships or conflicts of interest

Case Description: A 24-year-old male presented to the outpatient clinic referred to physical medicine & rehabilitation for evaluation of a musculoskeletal etiology of left lower quadrant abdominal pain. The symptoms had been ongoing for 3 years prior to presentation. He describes the pain as a constant twitching with spasms in the left lower quadrant, stating that “it feels like a tight muscle cramp that won’t let go.” The symptoms are intermittent, but he notes that it is much worse with exercises like sit-ups, or lying prone. The patient had been seen by GI and had undergone EGD and colonoscopy which were both unremarkable. He failed medication trials of Hyoscyamine and Amitriptyline. Lidocaine patches help the most with his symptoms.
On exam, the patient was noted to have exquisite tenderness to palpation in the left lower quadrant over the lateral rectus abdominis muscle, with decreased sensation over this area. He was noted to have a positive Carnett sign (pain with active abdominal flexion). A diagnosis of ACNES was suspected and the patient underwent injection with 60mg triamcinolone and 3.5 cc of 1% lidocaine mixture, locally to the left lower rectus muscle under ultrasound guidance.

Setting: Outpatient Physical Medicine Clinic

Patient: A 24-year-old male with chronic abdominal pain Assessment/

Results: The patient noted immediate relief after the injection and reported resolution of his abdominal pain symptoms one month after injection during his follow up visit with his gastroenterologist.

Discussion: ACNES is a nerve entrapment condition where the intercostal nerves of T7-12 can get “entrapped” in the abdominal muscles causing severe neuropathic pain in this area. This condition can be debilitating, and often under-diagnosed or misdiagnosed as an intrinsic gastrointestinal condition.

Conclusion: Abdominal Cutaneous Nerve Entrapment Syndrome does not commonly present to a physiatrist’s clinic, however proper recognition of this condition and intramuscular injection is an effective treatment for this condition.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/abdominal-cutaneous-nerve-entrapment-syndrome-treated-with-intramuscular-triamcinolone/