Anterior Cutaneous Nerve Entrapment Syndrome
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- Опубліковано 28 чер 2024
- An overview of the pathogenesis, clinical manifestations, diagnosis, differential diagnosis, treatment, and prognosis of the anterior cutaneous nerve entrapment syndrome (ACNES) - an important, often overlooked cause of chronic abdominal pain.
#abdominalpain #ACNES
![Abdominal Pain Causes by Location and Quadrant [Differential Diagnosis Chart]](http://i.ytimg.com/vi/fQq3KOaSMIM/mqdefault.jpg)
![Abdominal Pain Causes by Location and Quadrant [Differential Diagnosis Chart]](/img/tr.png)
It’s been about more than 1 year with a pain that goes up and down in my right abdomen. I have done every blood and urine test, abdominal imagery, gastroscopy. I have drank a ton of medicaments such as for gastric, gas pass, even a lot of flagyl, nidagyl (for parasites). A lot of pantoprazole, omeprazole. Going to doctor every week, I have spent e lot of monet. Bro I have remembered almost all these medicaments. Everyday thinking I have something like cancer. A lot of stress and depression. I left sugar, started drinking milk every morning because I thought I have stomach problems. Now I found this about ACNE. I think this is, because is the last thing that I have learned. I feel a bit happy now.
January 8th 2018, I corkscrewed myself while engaging the handle on a mid sized industrial mixing bowl. I not only felt, but could hear something rip in my left abdomen. My first thought was hernia. A visit to the emergency dept within the hour...
Over 4 years later I am still pleading with pain specialists to send me to a doctor that will actually try and repair the damage. I'm going insane. I do not take pain meds anymore, I couldn't function on Gabapentin/ Amitriptyline. Our health system would rather pay for pills than for a procedure that could significantly improve my quality of life. Pulsed radio frequency is my next attempt, I find out later this month if I am a candidate for the procedure. Godspeed!
try duloxetin and ashwagandha
Are you better now?
Would love an update on this as your situation seems very similar to mine! Also 2018, also felt something ‘rip’ and now I’m nearly 5 years on still in pain. Pleading with doctors but literally getting discharged next week after fighting for 3 rounds of nerve blocking injections, which have helped a lot! But yet they still haven’t checked me/done tests for nerve damage before these injections…. Despite me asking and begging them to before hand. Interesting. 🥴🥴
Please update gang
Thanks for putting efforts in making these videos.
Facing this problem , things that have helped me so far: Duloxetin 30mg, ashwagandha, don't stretch your ab, massages after shower, keep a good posture (try to be recline), walking
I saw a patient with this once, was a good case the fumbled me a bit. Had very good going allodynia. Neuropathic abdominal pain is often not that thought of but was a good reminder for future
My daughter gets a severe pain in her right side after 800m everytime she trys to go for a run. This is going on 3yrs now and have been to everyone for help but no luck. Cud this be it ?
@@lynxeffect84 I had rib pain for almost 20 years. I gave up trying to get a diagnosis after thousands of dollars in tests. Orthopedists said it was radiating from my spine. I knew it wasn’t. I said, “I don’t know how to explain how I know, but I promise you there is something wrong with my ribs and if you lived in this body you would know it too.”
I finally heard of a thoracic surgeon in West Virginia that was diagnosing and treating slipped ribs. I saw him and he was able to confirm I had three ribs with fractured cartilage that were “slipping”. The problem cannot be imaged except possibly with a dynamic ultrasound.
He did surgery to stabilize them but I also have rib tip syndrome. He wants to go back in but I’m not ready yet.
Many physicians have told me they have heard of the condition but that it is “rare”.
I reply that it is literally impossible to know how common or rare a condition is if it is nearly impossible to get it diagnosed.
We have no idea how many people out there are suffering in severe pain with no diagnosis or a diagnosis of a somatic disorder.
this is first time i hear about this clinical entity thanks doc
Thank you very much Doctor .
Thank you, very informative!
I was diagnosed with ACNES last year. I live in FL and had to travel to a hernia doctor in Beverly Hills who was able to confirm the diagnosis with the trigger point injections. I had a series of three injections with only temporary relief. I was referred to pain management to have nerve ablation done. I could not find a pain management doctor who would perform this due to the location (abdomen). My core became weak because I could not do any exercise that used my stomach muscles and I started to develop severe back pain. After MRIs and physical therapy I now have an appointment to see a pain management doctor that has agreed to do the ablation. I have been suffering with this since 2018 from an injury with lifting/twisting my body doing landscaping. I have seen multiple doctors, had my appendix removed, hysterectomy and all kinds of tests done.
Do you fell dizziness after eating?
I hope your're feeling better Simone!
Simone I live near volusia county in Florida. Where did you find your doctor that would help you? I'm looking for help with this also. Thanks. Hope you are doing better.
Also looking for a Dr that does nerve ablation! Anyone?
I have been going on circles for 20 months. Finally went to mass general and he thinks it is anterior cutaneous nerve. And he is sending me to pain dr to get shots. What helped and has anyone ended up w/ surgery? I am so perplexed and want my life back.😢
Very instructive thank you.
Thanks for the help
Exceptional description ❤
That was great video sir
Thanks alot
I believe that I may have just caused this to myself. Surprisingly, I think i did it while showering. I was scrubbing my right lateral abdomen while in a twisted trunk position.
No immediate pain was noted, however, later I noticed a stinging sensation on a point mid-lateral of the abdomen.
I'm hoping that this doesn't become a big issue.
Is it possible for ACNES to not trigger any pain upon external palpation, however hard, but induce a sharp localized pain upon either leg raises or crunches and sneezing (but not coughing, jogging, weight lifting or pretty much any activity where the rectus abdominis isn’t a primary mover)? Doctors have rules out hernia.
I experienced acnes for over 30 years but didnt know it. It was very sporadic in the beginning but so painful 3 years ago. I was diagnosed by my gastroenteroologist in my town in thailand. He recommended losing weight, taking B vitamins and nortriptyline and senakot. Since losing 10 pounds has made a world of difference. Its not so painful now. Only wben i do difficult abdominal yoga poses. When that happens, i use Salonpas pain patches. It really helps and i rarely use them now. When it does flare up, i know i have gain weight and need to work harder at the gym, eat healthier to get the weight down.
What type of drug you take pls
This sounds exactly what I get, I have had it twice this year and another 2 to 3 times in my life with the first being about a 10 years ago. Its exactly the place where I somehow managed to shove my Bike Handle into during a biking accident about 20 years ago.
Eventually it sorts itself out and te longest bouts of it can last up to 7 -8 hours before it comes right slowly. The Pain can be a 10 out of 10.
Can the pain feel like a Charlie horse? That’s what I feel on my LUQ. I have thoracic outlet syndrome and I’ve already had ablation done. But this is painful I have DVTs and my legs from having Cove it twice in January and putting those on there are times when I get what feels like a Charlie horse so bad I move and I feel like it takes my breath away. I can’t even sit in one of our recliners without it triggering a spasm. Not sure if it’s this or not but it’s been difficult to diagnose
After 6 year's of seeing different Dr's all saying ibs? I'm finally getting the ultrasound next month that I've been begging for!🥺 I 🙏 it's an abdominal nerve entrapment and I get my life back! 🙂
I'm pretty sure i have this or another similar nerve injury from endometriosis surgery. I have a spot of weird sensation on my skin about an inch diagonally left from my belly button. It's round and about 2-3 inches across. It feels hard and isn't always sensitive to firm touch, but it's very very sensitive to light touch and seems to cause more radiating pain up my flank and into my back and ribs. So bad that sometimes And i already gave a billion other health issues and chronic injuries in my feet, knee, back...i have actually lost my primary care doctor because they didn't believe me so they thought i was just trying to get drugs (which i never asked for or received). Been to so many specialists. I've gone to pelvic PT for 12 weeks. Had multiple MRIs. Heart monitor due to radiating chest pain. Everything seems normal despite the fact I'm in excruciating pain and losing tons of weight, so much that I'm now losing muscle. Nobody is listening. I should just come out and say this is what i think is wrong. I accept that my surgery had risks and i don't blame my surgeon. I just want to feel better.
How do you differentiate from slipped rib syndrome?
Oh, i had sepsis in my spine and a rod placed in my thoracic area.
Had a lumbar spinal fusion where they entered from the front and moved everything did my back surgery then moved everything back. My stomach pain after surgery hurt more not the incision but on the left side. I could not even walk 1 mile without having to sit down. It has been 4 months now and I can walk further but if I stand more than 2 hours it starts hurting again and I have to sit or lie down. Should I just wait and hope it gets better or is there anything I can do to help it heal.
Suffering from this with my first pregnancy. Praying it goes away after birth when the internal pressure is relieved.
Did it go away? I'm in so much pain and I'm not due for 2 more months
@@tonyawerner707 it went away as soon as I gave birth! The best way I found to manage the pain was movement. It was always worst after a day sitting at a desk and best after a day of housework or going for walks. Heat packs helped a little too. Hang in there!!
@@tessmccririck2185 thank you hun! I noticed sitting for too long irritates it more too. At least I know it will go away. The thought of it not made me cry a bit lol
I have this, mine is so bad, I've had it since robotic gull bladder removal. About 10 yrs now. I went 3 yrs ago to a gastroenterologist and he gives me amitriptyline at bedtime and hyoscyamine during the day. But it still flares up from time to time, like today, it's hit me out of the blue, and I'm in absolute misery.
I think this it what I have, I get severe RUQ pain after I stand or walk, the pain is also in my back but I get a severe pain in the same spot in my RUQ that I can pinpoint with two fingers. Pain medicine does not help it. I just went to a GI and she said she doesn’t treat abdominal wall entrapment and doesn’t even know any GI’s that do. She didn’t even perform any test to see if that’s what I have. I’m so frustrated and the pain is debilitating and interfering with everyday activities. I even asked if she could order trigger point injection but said she would have to do a scope first to rule out other possibilities even though I have no GI symptoms. My primary doctor sent me to physical therapy and that didn’t help, I follow up with her next month :(
Thomas Gillespie M.D., St. Joseph Hospital, Phoenix AZ, does robotic surgery for A.C.N.E.S. Good luck!
Hi mine goes into my back too and right shoulder but starts at my right upper quadrant. It hurts every day so bad. 800 mg ibuprofen does not help, neither does Tylenol or anything else. It’s Terrible 10/10 at times. 🥺
I have alodynia!! I got a diagnosis of colitis, because is in my left lower side, tested all, ultrasound, blood in stool, colonoscopy, labs looking for cancer sings, only missing CT but it is too much money! I am dealing with the colitis quite decently and pain is not improving that much. One little spot feeling a needle and quite close to the surface.
I think I may have this
Hi! Is tenderness to touch a key indicator for ACNES? I am wondering if I might have ACNES but I do not have tenderness to touch. I understand you are not able to diagnose- just curious if ACNES can still be a possible diagnosis without this symptom?
I am hardly an expert at this condition, but I would imagine it's quite uncommon for a patient with ACNES to have absolutely no tenderness to palpation at the "trigger point" on exam, but it seems likely that for some patients, the palpation needs to be relatively firm to bring it out, and/or that the location of the trigger point and the location of where the pain is felt may not be precisely the same. However, I always recommend to viewers that they speak with their own physicians about personal health questions. I hope you find an answer to your symptoms!
Just curious, are there “flares” when the pain becomes very bad? I have ebbs and flows for the past 13years. When having a flare, Ivan push on a specific area of lower central abdomen and it is sore and uncomfortable. But if a Dr tries to gently to moderately apply pressure when not having a flare, it’s not bothersome. It feels like there is a very specific spot that is “twisted” for lack of better term.
I’ve had Gynocologist exams, internal Vag ultrasounds, urodynamic testing, cystoscope (as they thought perhaps IC-more frequent trips to urinate during a flare), CT and ultrasound of belly and colonoscopy.
Slight detection of a “varicose vein” internally-forget what that’s called, but not a classic diagnosis to put a valve in.
I’m so tired of it😢
My trigger point seems to be sensitive to heat pad. It's more of an annoyance right now. I lifted 60# stroller onto right hip; hyperextended back and now this and ASISpine are kicking my butt. Oh joy.
Thanks for sharing. I know this disease for the very first time.
Doing leg raises after weights. Bam - pain in a very small, specific spot in my upper right abdominal wall. A stabbing burning pain. Hurts if I press it or lift my legs. Darn it. I've lost a load of weight, am middle aged, female. So fit the criteria. I am going to try and treat it myself with anti-inflammatory drugs, gentle core and try and release that nerve. My oh my it was painful! This is not going to stop me on my fitness journey!!
Did it ever get better? I'm trying to resolve at home post lifting heavy stroller up 2 flights of stairs.
@@rebeccahall4559 yes it got better - with total rest. Took over a week to settle down and I didn't do anything that even remotely started the pain - so no gym leg raises. I could carry on moving and running. Just not doing anything that started that pain off. So to answer your question - no more stroller lifts! I hope this helps.
I had a gastric bypass in 2018 I believe I have this but cannot find a Dr. To treat or diagnose it. I have had CT, ultrasound, xray, endoscopy , colonoscopy etc etc and none show anything . I live in northeast Florida in Putnam/Volusia County and need a Doc who can treat this!
Have you found a doctor in volusia? I live close to there as well and am looking also .
This sounds very familiar! Does anyone else get a cramp like feeling when they bend down to tie their shoes, or move in the wrong way? I can actually feel the muscles involved when I touch it. Pain seems to be mostly on the upper right, but have gotten it in different areas of the abdomen. I have Cervical and Lumbar Spine Issues and had emergency Cervical Myelopathy surgery a few years ago. Your thoughts on this? Thank You.
I’ve also had this exact issue. Upper right abdomen spasms when I bend down in a weird way and I can definitely feel movement when I put my hand where it hurts. I also had Spinal fusion surgery for a large S curve in my upper back, but I’ve had this issue pre and post op.
@@Cayreb Thank You for your answer Cayreb! I hope you're feeling better! I am, but I'm still worried the spasms will come back!
I get cramps in intercostal muscles and some muscles of the upper back. I have slipping rib syndrome and rib tip syndrome.
So im not the only one what did anyone do against thet guys i have problema with IT since 2015 would appreciate every advice
@@nomercy1310 I’m truly sorry but I’m not sure what you are asking.
But I had surgery to plate my ribs together.
I’ve been dealing with this for 11 years and nothing I’ve had done has helped
I tried 2 spinal cord stimulation devices had them removed as it only worked for the 5day trial• SCS does not work for *severe abdominal adhesions.*
Hoping you find relief.
I was diagnosed with ACNES in 2014. And absolutely nothing has helped. I have had trigger point injections and discovered I am allergic to steroids, nerve ablation, tried all the drugs and have been in physical therapy with dry needling into my abdomen for 3 years. finding a surgeon to do the neurecromy has been impossible.
Please do not give false hope with an excellent chance of improvement, I see more people that can't get relief than can in my ACNES support group.
I'm very sorry to hear about your situation. I obviously don't know any details beyond what your comment includes, and I can't give any specific, individualized medical opinion here - however, keep in mind that folks who have resolution of their symptoms are much less likely to be found in an online support group. Thus, support groups for any illness tend to be composed of patients with either unusually severe cases, or with challenges receiving appropriate treatment that are beyond their control. I hope the future brings you more pain relief, and more options for treatment of this condition.
Where did you find an ACNES support group?
Sir, do you have any video on obstructive sleep apnea or sleep related breathing disorder? in which segment if yes?
No, I'm sorry, I don't have any videos on those topics yet.
14 years ago I am suffering from unknown high abnormal pain , it is like burning or electricity . Many tests from different Doctor was done, but not detect the cause of pain. My all internal parts are narmal and safe. I tried to read books by searching the cause of pain and found nothing.
We confused this pain with intestine disease or stomach. The all test resulting normally. I took many stomach medicine s ( decreases acidity).
Tomorrow, the Gastroenterologist Doctor from American performed 3rd Endoscopy and found nothing, she palpated the area where I showed. I felt pain from palpitations.
She told me that, the pains is not from intestine,in stomach or elsewhere. She concluded that the pain comes from abdominal wall ( muscles or nerves).
I become confused about that, I tried to search more about it on Internet. And I'm finding the real cause of my pain.
Now I know less about this disease, I ask a help to all of you who knows more about this disease (give me informations about it).
Is this conditions has end? Or curable??? Tell me please.
I'm from Rwanda/Africa.
Thanks again informative video• I've learned words Neva told to me as a chronic abdominal adhesion pain person• I have a complex case of intractable severe abdominal pain• 2 SCS didn't work for me• can you kindly respond please• 8:13:2022
Can food/eating affect a “flare up”? I’m currently waiting on tests to confirm this is what is causing my continued upper abdominal pain. I’ve been dealing with it for over 2 years now unchecked till recently, and it seems to be more intense after eating certain foods; though it’s almost ever present, after a meal I feel the muscles start to spasm and the pain (almost a pressure) is more intense.
I can't offer specific, individualized medical advice, and I always recommend viewers speak with their own physicians. However, ACNES is unrelated to the GI system, and is neither triggered by eating in general, or by any one specific food.
I can confirm having this same experience. About 3 bites in & the pressure comes on. It's actually more comfortable to just stay standing while I eat. Sitting definitely sets it off. Hope you find relief soon
me too, same problem and I believe it's because internally it generates air moving muscles and creating internal pressure
@@jennalynnharvey9287 do you fell dizziness as well after eating after that ACNES symptoms?
I get the same type of symptom from food. I don't know exactly but I imagine that maybe when hard food goes through the colon it can cause pressure on the nerve? whereas soft food does not?
Would intense physical therapy help?
Had a motorcycle accident a few years ago and broke many bones and tore muscles.. off. This is one of the last remnants of that wreck. A big knot on my lower abdomen that flared up when I started working out again recently.
I can't provide specific, individualized medical advice here, but physical therapy is not part of the conventional approach to treatment of ACNES.
OH, I HOPE YOU CAN HELP! I've had chronic pain at my RIGHT WAISTLINE, for 16+ months. I've been ping-ponged all over my entire Healthcare system and STILL NO DIAGNOSIS- OTHER THAN GASTROPARESIS!. However, with NO ROOT CAUSE DIAGNOSIS! I've even had a chlorcystectomy, even though I did not present with normal symptoms. Pain remained. PT for the ililoinguinal muscle,(?) Proved futile. Not diabetic. Car accident 27 years ago. Totally disabled. Diskectomy at L4/5 S 1. Neurosurgeon ordered new thoracic MRI but, says although DDD apparent, some bulging, doesn't believe enough impingement for radiculopathy. Neurologist's EMG shows nerves working appropriately given prior history. Now, back to gastroenterologist next week!! WHEN DO I GET OFF THIS MERRY- GO- ROUND? Can't ANYONE help me? I know a woman of a certain age has a LOT, of "gray areas" that overlap but, this is ridiculous and UNACCEPTABLE! I HAVE A LIFE TO LEAD! PLEASE ADVISE, THANK YOU IN ADVANCE 🙏
I so sorry to hear about what you've been through. Unfortunately, I can't offer specific, individualized medical advice here.
Try seeing a dr with subspecialty in pain intervention. This can typically be an anaesthesiologist, a gastrologist, an orthopaedic surgeon or a neurosurgeon.
I am a dr myself, currenty at 19 weeks pregnancy. My obgyn initially thought i had adhesion colic from a previous abdominal surgery. After doing some reading on chronic neuropathic pain on the abdo wall, i realised tht i have ACNES. Thankfully i found a pain interventionist and just underwent a nerve block earlier today. My pain scores fell significantly and can finally breathe easy after 2 weeks of persistent pain. I hope my pregnancy will proceed unremarkably from now on. All the best to you. 🇲🇾❤
I feel for pain. At 35, I’m very over not having answers.
after all the treatments en operations for acnes now left with one acnes very painfull spot in abdomen. now a new docter tells us that acnes is theorie. and all tissue heals after 6 months. so that there is no pain from acnes but it is in my head!! what is your preception on this? the pain team tells us that we have done everything possible and they can not oparate again. is acnes healed after 6 months or is this docter unaware of acnes? hope you can tell me if i am wrong. acnes is proofed by anestest.
I'm very sorry to hear about what you are experiencing, but I can't give specific, individualized medical advice here. Everyone's situation is different.
i am suffering from abdominal pain for last 5 months.it is persistent. worsed with movement like rotating, standing up or walking. chest heavyness and chest discomfort also present. pain also starting in my both groin and vulva which is also increased with any kind of movement. abdominal ct scan reveals nothing significant. I have history of caesarian section in May 2022, followed by peristent loose moton for 3 months. Then i have done colonoscopuy revealed internal haemorrhoid, then loose motion was improved. but after one month i developed sudden abdominal pain along with chest heavynes. i feel jerky movement or something waving in my abdomen . would you please help me. i am dissapointed as severel investigations i have done and i have consulted with surgeon, gastroenterologist
I so sorry to hear about your symptoms and the struggle you've had at finding a diagnosis. Unfortunately, I can't offer specific, individualized medical advice on here. I do have a video on chronic abdominal pain; you may find something discussed there resembles what you've been experiencing: ua-cam.com/video/qfVHJQu-dfw/v-deo.html
What type of doctor should we see for treatment of this ACNES syndrome?? My general practitioner just says to take anti inflammatory and it’s not helped
A pain management specialist is the best option, but unfortunately there are many geographic locations where this is not available. Few GPs/PCPs are trained to do trigger point injections, which is the cornerstone to treatment.
You mention that the focal point is only one side. My daughter has 2 focal points either side of her belly button. She is carnet positive. She was infiltrated but only caused more pain for 5-6 days. She is in pain 24 hrs a day, intensity varies. Also nausea, and when pain extreme will vomit. Would you not consider ACNES as pain both sides of belly button?
Each anterior cutaneous nerve caries pain sensation from one side of the body. While there is no specific reason that ACNES could affect a nerve on the right and left side of the abdomen at the same time, that would be unusual. I'm sorry but I can't give individualized medical advice here, and recommend speaking with her daughter about the possibility of alternative diagnoses.
I am wondering if ACNE can also cause headaches on the same side as the abdominal pain.
Yes. I have headache on same side
is it the pain you experience occasionally while running?..the explanation feels so familiar🤔🤔
I'm afraid I can't give specific, individualized medical advice here, but in general, a pain that develops in a person's side *only* with running is probably not ACNES.
Looks like I have a video to send to my lazy VA doctor. I'm so sick of hearing that I'm making things up.
I've had a tooth ache-like nerve pain in my left abdomen that wraps around to my left back since the end of May 2023. It's so severe and need help! Maybe this might be partially the cause. I have had CT scans, MRI and blood tests and it's not attributed to anything they have been able to find. I am in utter misery all the time and any movement of the abdomen hurts so my only relief is when I sleep and wrap my abdomen and back with ice packs. 😰🙏
I prayed that our Lord and God heals your condition immediately, and will pray again. Lift me in prayer also as I have it bad. May The Lord bless all of your efforts! amen
@rambido Thank you so much for praying for me and I'm praying for you right now!!!! 🙏❤️
I have the same symptoms as u explained. the pain is occasional
it appears if i shout or in anger.
presently I'm preparing for exams. please suggest me any asanas or exercise to recover. pain is acute.left side lower abdomin I'm 27 years old
Did you recover? Kya Kiya apne?
@@PramilaDevi-mu9fu I am just staying active and doing suggested asanas
@@pooja-qj9cn can you tell me those asanas plz I'm suffering from this issue
I underappreciate the metal guitar riff for the introduction of this video lolz
What type of doctor treats this type of pain? Do all gastroenterologist treat it? or a surgeon?
In the US, the most appropriate specialty to see for this would be an anesthesiologist who specializes in pain management. If the diagnosis is relatively certain, a referral to a peripheral nerve specialist would be a good alternative. While either a gastroenterologist or a general surgeon should be able to make the diagnosis, I doubt many of either specialty would be trained to do the trigger point injections which are the central feature of treatment.
What doctor should I ask for
An internist should be able to more-or-less make the diagnosis, though you may need to remind them that ACNES exists! However, the hallmark finding of the condition - pain relief with a trigger point injection of a topical anesthetic - would usually require a visit to a pain management specialist (at least here in the US).
@@StrongMed thank you , there’s an incredibly long wait for my pain management in my city , pretty much my state but hoping for the best when my turn comes around
Nice video, but I miss the Bach fugue...
Thanks for the comment. Every series has its own theme music; I know that it's kind of random that it alternates between Bach and metal.
👍👍
I have experience with same pain from last 1 year and some times it’s start swelling over there on trigger point when I worked hard. Some time showing redness on trigger point as well when I done something hard. What i need to do.