Several mechanisms have been suggested to underlie the pathogenesis of AWP. Entrapment of the anterior cutaneous nerve appears to be the most common. Applegate suggested that the anterior cutaneous nerve, which arises from the T7 to T12 intercostal nerves, makes two 90° turns before reaching the skin. It usually slides unimpeded and buffered by fat in the neurovascular bundle. An entrapped nerve may either be pushed by intra-abdominal pressure or pulled by a scar. Other causes of AWP include hernias, hematomas or myofascial trigger points. Neuromas from scars , endometriosis in the abdominal wall , desmoid tumours and intra-abdominal adhesions have also been implicated. Finally, superficial lesions such as herpes zoster may mimic AWP. In the present study, we investigated the long-term outcomes of patients who received trigger point injections (TPI) in a gastroenterology clinic for AWP. We determined the diagnostic tests that were ordered in its workup and the direct costs of investigating the pain. You will be glad to come across cheap asthma inhalers costing you very little money.
Category: Abdominal wall pain
Tags: Abdominal wall pain, Carnett sign, Trigger point injection