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Anterior cutaneous nerve entrapment syndrome (ACNES) is a nerve entrapment condition that causes chronic pain of the abdominal wall. [1] It occurs when nerve endings of the lower thoracic intercostal nerves (7–12) are 'entrapped' in abdominal muscles, causing a severe localized nerve (neuropathic) pain that is usually experienced at the front of the abdomen.
Treatment options usually involve rest, pain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), ice, heat, and manual therapy. Cases with persistent discomfort may be managed with an intercostal nerve blocking injection utilizing a combination of corticosteroids and local anesthetic. The condition predominantly affects women ...
The intercostal nerves are part of the somatic nervous system, and arise from the anterior rami of the thoracic spinal nerves from T1 to T11. [1] [2] The intercostal nerves are distributed chiefly to the thoracic pleura and abdominal peritoneum, and differ from the anterior rami of the other spinal nerves in that each pursues an independent course without plexus formation.
Injecting local pain relievers and steroids into the injured area alleviates intercostal nerve pain. [2] In this type of nerve block, a needle inserted between two ribs releases a steroid into the area around the nerve. The exact location of injection depends on the underlying cause of the injury.
Conservative measures are often the first forms of treatment offered to patients with slipping rib syndrome, especially those in which symptoms are minor. [16] Often the patients will be reassured and recommended to limit activity, use ice, and take pain medication such as nonsteroidal anti-inflammatory drugs (NSAIDs). [ 4 ]
The primary symptom is pain and it may be localized to the distribution of one or more of the intercostal nerves, manifesting as chest and abdominal pain. [18] No treatment modality prior to neurectomy (e.g. systemic medications, cryoablation, therapeutic nerve blocks, and radioablation) has given effective pain relief and none have been curative.
Affected individuals have a constant migraine-like headache and experience pain in all three trigeminal nerve branches. This includes aching teeth, ear aches, feeling of fullness in sinuses, cheek pain, pain in forehead and temples, jaw pain, pain around eyes, and occasional electric shock-like stabs.
The underlying cause is unclear. Some believe the pain may be from the chest wall or irritation of an intercostal nerve. [1] [2] Risk factors include psychological stress. [2] The pain is not due to the heart. Diagnosis is based on the symptoms. Other conditions that may produce similar symptoms include angina, pericarditis, pleurisy, and chest ...