How is Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) diagnosed?

Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) is primarily diagnosed through a clinical physical examination using the Carnett’s sign, which demonstrates localized abdominal wall tenderness that worsens when the abdominal muscles are tensed. Because there is no single blood test or diagnostic imaging scan that confirms the condition, diagnosis relies heavily on the exclusion of intra-abdominal pathologies and the successful response to a diagnostic nerve block.

How is Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) diagnosed?

The diagnostic process for Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) often begins by ruling out visceral conditions. Physicians typically perform a thorough physical exam to identify trigger points along the rectus abdominis muscle. A positive Carnett’s sign—where pain increases upon lifting the head or legs while supine—is the hallmark clinical indicator of ACNES. To confirm the diagnosis, clinicians often perform a diagnostic lidocaine injection into the tender area; if the pain resolves significantly, it strongly supports the diagnosis of ACNES.

What tests and examinations are used for ACNES?

There is currently no specific genetic test or biopsy for Anterior Cutaneous Nerve Entrapment Syndrome (ACNES). Instead, doctors use a "diagnosis of exclusion" approach:

• Clinical Physical Exam: Specifically testing for Carnett’s sign.


• Imaging: Ultrasound or CT scans are often ordered to rule out hernias, gallstones, or other internal organ issues.


• Diagnostic Nerve Block: Injection of a local anesthetic into the most painful point of the abdominal wall.


• Blood/Urine Tests: Used only to exclude inflammatory or infectious processes.

Why is the diagnostic odyssey so long for ACNES?

Many patients with Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) face a lengthy "diagnostic odyssey" because the symptoms mimic common digestive issues like IBS, endometriosis, or chronic appendicitis. It is common for patients to undergo unnecessary surgeries or extensive GI workups before a provider recognizes the nerve-related nature of their pain. At DiseaseMaps.org, 36 members have shared their experiences, highlighting the frustration of being misdiagnosed. If your primary care doctor is unfamiliar with ACNES, it is vital to seek a consultation with a surgeon or pain management specialist who is experienced in abdominal wall pain syndromes.

Next steps

• Consult a general surgeon or a pain management specialist familiar with abdominal wall entrapment.


• Keep a detailed pain diary to share with your physician, noting what triggers your abdominal pain.


• Join the Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) community at DiseaseMaps.org to connect with others who have navigated the diagnostic process.

Medical disclaimer: This information is for educational purposes only and does not constitute professional medical advice, diagnosis, or treatment.

References

• NIH GARD (Genetic and Rare Diseases Information Center) - Anterior Cutaneous Nerve Entrapment Syndrome


• Orphanet: A Database of Rare Diseases


• PubMed: "Diagnosis and Treatment of Anterior Cutaneous Nerve Entrapment Syndrome"


• The Journal of the American Osteopathic Association: Clinical Review of Abdominal Wall Pain