Abdominal cutaneous nerve entrapment syndrome

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The abdominal cutaneous nerve entrapment syndrome (ACNES) consists of pain caused by entrapment of the abdominal segmental nerves within the rectus abdominis muscle. Intercostal neuralgia appears to be a restricted form of ACNES.

According to one clinician, " Abdominal cutaneous nerve entrapment syndrome (ACNES) may sound like an esoteric condition rarely seen by clinicians but is a common condition. When a patient is seen for abdominal pain without other clinically significant symptoms, ACNES should be high on the list of likely diagnoses. " [From Applegate 2002---see reference below.]

A typical intercostal space has the following cutaneous supply from behind forwards -dorsal rami of thoracic spinal nerve -lateral cutaneous branch of ventral rami -collateral branch of VR(may be present) -anterior cutaneous branch of ventral rami Thus the entire IC space receives cutaneous supply from a single spinal nerve.Compression of the nerve at its origin or anywhere along its course may cause neuropathic pain along its supply.

References

• William V Applegate, MD, FABFP (2002). "Abdominal Cutaneous Nerve Entrapment Syndrome (ACNES): A Commonly Overlooked Cause of Abdominal Pain.". The Permanente Journal 6 (3). http://xnet.kp.org/permanentejournal/sum02/acnes.html. 

Abdominal Cutaneous Nerve Entrapment Syndrome (ACNES): A Commonly Overlooked Cause of Abdominal Pain By William V Applegate, MD, FABFP

• Roumen R, Scheltinga M (2006). "[Abdominal intercostal neuralgia: a forgotten cause of abdominal pain]". Ned Tijdschr Geneeskd 150 (35): 1909–15. PMID 16999272. 
• Applegate W, Buckwalter N (1997). "Microanatomy of the structures contributing to abdominal cutaneous nerve entrapment syndrome.". J Am Board Fam Pract 10 (5): 329–32. PMID 9297657.