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Current Pain and Headache Reports

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10-02-2024 | Abdominal Pain | Chronic Pain Medicine (O Viswanath, Section Editor)

The Diagnostic Value of Carnett’s Test with Chronic Abdominal Pain: A Narrative Review

Authors: Xiao-Xiao Sun, Heng Liu, Xiang-Zheng Qin, Mei-Rui Li, Qing-hua Yan, Guang-Jian Zhang

Published in: Current Pain and Headache Reports | Issue 4/2024

Abstract

Purpose of Review

Chronic abdominal wall pain is a poorly recognized cause of chronic abdominal pain, and patients frequently go misdiagnosed despite a battery of medical tests. The Carnett’s test is a diagnostic tool used to distinguish between abdominal wall pain and visceral pain. This review synthesizes the current literature on the Carnett’s test, merges the viewpoints of diverse writers, and evaluates and reports on the Carnett’s test’s applicability.

Recent Findings

Several clinical investigations have established the usefulness of the Carnett’s test in the diagnosis of chronic abdominal wall pain. Furthermore, the Carnett’s test is quite useful in determining the depth of the mass and detecting psychogenic abdominal pain. However, its diagnostic use for acute abdominal pain is limited.

Summary

The Carnett’s test is a simple and safe point-of-care diagnostic technique, with several studies supporting its usefulness. Early detection of abdominal wall pain is critical for chronic abdominal wall pain therapy. Carnett’s test is very useful in patients with chronic, unexplained local abdominal discomfort who are compliant and do not have a clear rationale for surgery.

Gray DW, Dixon JM, Seabrook G, Collin J. Is abdominal wall tenderness a useful sign in the diagnosis of non-specific abdominal pain? Ann R Coll Surg Engl. 1988;70(4):233–4.PubMedPubMedCentral

Greenbaum DS, Greenbaum RB, Joseph JG, Natale JE. Chronic abdominal wall pain: diagnostic validity and costs. Digest Dis Sci. 1994;39(9):1935–41. https://doi.org/10.1007/BF02088128.CrossRefPubMed

Carnett JB. Intercostal neuralgia as a cause of abdominal pain and tenderness. J Surg Gynecol Obstet. 1926;42:625–32.

Applegate WV. Abdominal cutaneous nerve entrapment syndrome (ACNES): A commonly overlooked cause of abdominal pain. Perm J. 2002;6(3):20–7.PubMedCentral

Thomson H, Francis DMA. Abdominal-wall tenderness: a useful sign in the acute abdomen. The Lancet. 1977;310(8047):1053–4. https://doi.org/10.1016/S0140-6736(77)91885-2.CrossRef

Greenbaum DS, Joseph JG, Hall MW, Sowden DS, Gravestock N, Freeman E. Abdominal wall tenderness test. Lancet. 1991;337(8757):1606–7. https://doi.org/10.1016/0140-6736(91)93301-O.CrossRef

Costanza CD, Longstreth GF, Liu AL. Chronic abdominal wall pain: clinical features, health care costs, and long-term outcome. Clin Gastroenterol Hepatol. 2004;2(5):395–9. https://doi.org/10.1016/S1542-3565(04)00124-7.CrossRefPubMed

Young SE, Levsky ME, DeKay KB, Dunn JD. A prospective evaluation of Carnett’s test for acute abdominal pain in the emergency department. Ann Emerg Med. 2007;50(3Suppl):S77.CrossRef

Takada T, Ikusaka M, Ohira Y, Noda K, Tsukamoto T. Diagnostic usefulness of Carnett’s test in psychogenic abdominal pain. Internal medicine (Tokyo, Japan). 2011;50(3):213–7. https://doi.org/10.2169/internalmedicine.50.4179.CrossRefPubMed

10.

Siawash M, Roumen R, Ten WTA, van Heurn E, Scheltinga M. Diagnostic characteristics of anterior cutaneous nerve entrapment syndrome in childhood. Eur J Pediatr. 2018;177(6):835–9. https://doi.org/10.1007/s00431-018-3125-y.CrossRefPubMed

11.

• Mol FMU, Maatman RC, De Joode, Luuke E G H, van Eerten P, Scheltinga MR, Roumen R. Characteristics of 1116 consecutive patients diagnosed with anterior cutaneous nerve entrapment syndrome (ACNES). Ann Surg. 2019;273(2):373–8. https://doi.org/10.1097/SLA.0000000000003224. The largest case series on the use of Carnett’s test in patients with abdominal wall pain.CrossRef

12.

• Darracq MA. Clinical Utility of Carnett and closed eye sign in emergency department. Am J Emerg Med. 2020;38(12):2759.e1–2759.e4. https://doi.org/10.1016/j.ajem.2020.05.077. This prospective observational study confirmed that Carnett’s test is not suitable for acute abdominal pain.CrossRefPubMed

13.

García RC, Botija AG, Recio LA, Nieto IC, Barrio MA. ACNES syndrome, exploring the abdominal wall as source of abdominal pain. Andes Pediatr. 2022;93(1):86–92. https://doi.org/10.32641/andespediatr.v93i1.3619.CrossRef

14.

Knockaert DC, D’Heygere FG, Bobbaers HJ. Ilioinguinal nerve entrapment: a little-known cause of iliac fossa pain. Postgrad Med J. 1989;65(767):632–5. https://doi.org/10.1136/pgmj.65.767.632.CrossRefPubMedPubMedCentral

15.

Campanelli G. Pubic inguinal pain syndrome: the so-called sports hernia. Hernia. 2010;14(1):1–4. https://doi.org/10.1007/s10029-009-0610-2.CrossRefPubMed

16.

McPeak AE, Allaire C, Williams C, Albert A, Lisonkova S, Yong PJ. Pain catastrophizing and pain health-related quality-of-life in endometriosis. Clin J Pain. 2018;34(4):349–56. https://doi.org/10.1097/AJP.0000000000000539.CrossRefPubMed

17.

Simonet WT, Saylor HL, Sim L. Abdominal wall muscle tears in hockey players. Int J Sports Med. 1995;16(2):126–8. https://doi.org/10.1055/s-2007-972978.CrossRefPubMed

18.

Cherry WB, Mueller PS. Rectus sheath hematoma: review of 126 cases at a single institution. Medicine (Baltimore). 2006;85(2):105–10. https://doi.org/10.1097/01.md.0000216818.13067.5a.CrossRefPubMed

19.

Stoehr JR, Chappell AG, Dumanian GA. Kiteboarding induced abdominal wall pain: intercostal neuroma versus anterior cutaneous nerve entrapment (ACNES). Plast Reconstr Surg Glob Open. 2021;9(3):e3487. https://doi.org/10.1097/GOX.0000000000003487.CrossRefPubMedPubMedCentral

20.

Sharp HT. Myofascial pain syndrome of the abdominal wall for the busy clinician. Clin Obstet Gynecol. 2003;46(4):783–8. https://doi.org/10.1097/00003081-200312000-00007.CrossRefPubMed

21.

• Koop H, Koprdova S, Schürmann C. Chronic abdominal wall pain. Dtsch Arztebl Int. 2016;113(4):51–7. https://doi.org/10.3238/arztebl.2016.0051. An in-depth overview of Chronic Abdominal Wall Pain.CrossRefPubMedPubMedCentral

22.

Otero W, Ruiz X, Otero E, Gómez M. Chronic abdominal wall pain: an unrecognized entity with great impact in the clinical practice. Rev Colomb Gastroenterol. 2007;22(4):261–71.

23.

Tanizaki R, Takemura Y. Anterior cutaneous nerve entrapment syndrome with pain present only during Carnett’s sign testing: a case report. BMC Res Notes. 2017;10:1–4. https://doi.org/10.1186/s13104-017-2816-1.CrossRef

24.

Schneiderman H, Lopetegui-Lia N, Nichols J. The enduring and practical power of physical examination: Carnett sign. Am J Med. 2020;133(6):682–4. https://doi.org/10.1016/j.amjmed.2019.09.027.CrossRefPubMed

25.

Uehara T, Noda K, Tsukamoto T, Fujimoto H, Horikoshi T, Ikusaka M. Manubriosternal arthritis/osteitis: chest wall pain aggravated by Carnett’s sign posture. Am J Med. 2021;134(8):e455–6. https://doi.org/10.1016/j.amjmed.2021.01.041.CrossRefPubMed

26.

Kijima T, Hyakudomi R, Hashimoto T, Kusaka A, Nakatani T, Ishibashi Y. Adhesion-induced chronic abdominal pain: a case report on the diagnostic value of Carnett’s test. J Med Case Reports. 2019;13(1):93. https://doi.org/10.1186/s13256-019-2026-7.CrossRef

27.

Boelens OB, Scheltinga MR, Houterman S, Roumen RM. Management of anterior cutaneous nerve entrapment syndrome in a cohort of 139 patients. Ann Surg. 2011;254(6):1054–8. https://doi.org/10.1097/SLA.0b013e31822d78b8.CrossRefPubMed

28.

Boelens OBA, Scheltinga MR, Houterman S, Roumen RM. Randomized clinical trial of trigger point infiltration with lidocaine to diagnose anterior cutaneous nerve entrapment syndrome. Br J Surg. 2013;100(2):217–21. https://doi.org/10.1002/bjs.8958.CrossRefPubMed

29.

Boelens OB, van Assen T, Houterman S, Scheltinga MR, Roumen RM. A double-blind, randomized, controlled trial on surgery for chronic abdominal pain due to anterior cutaneous nerve entrapment syndrome. Ann Surg. 2013;257(5):845–9. https://doi.org/10.1097/SLA.0b013e318285f930.CrossRefPubMed

30.

Maatman RC, Steegers MAH, Boelens OBA, et al. Pulsed radiofrequency or anterior neurectomy for anterior cutaneous nerve entrapment syndrome (ACNES) (the PULSE trial): study protocol of a randomized controlled trial. Trials. 2017;18(1):362. https://doi.org/10.1186/s13063-017-2110-5.CrossRefPubMedPubMedCentral

31.

Mol FMU, Roumen RMH. DRG spinal cord stimulation as solution for patients with severe pain due to anterior cutaneous nerve entrapment syndrome: a case series. Neuromodulation. 2018;21(3):317–9. https://doi.org/10.1111/ner.12692.CrossRefPubMed

Title: The Diagnostic Value of Carnett’s Test with Chronic Abdominal Pain: A Narrative Review
Authors: Xiao-Xiao Sun
Heng Liu
Xiang-Zheng Qin
Mei-Rui Li
Qing-hua Yan
Guang-Jian Zhang
Publication date: 10-02-2024
Publisher: Springer US
Keyword: Abdominal Pain
Published in: Current Pain and Headache Reports / Issue 4/2024
Print ISSN: 1531-3433
Electronic ISSN: 1534-3081
DOI: https://doi.org/10.1007/s11916-024-01223-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The Diagnostic Value of Carnett’s Test with Chronic Abdominal Pain: A Narrative Review

Abstract

Purpose of Review

Recent Findings

Summary

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

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