Adam T. Schulman, MD
Resident Physician
Mount Sinai Hospital
NYC, New York, United States
Zachary Tenner, BA
Medical Student
NYU LI COM
New York City, New York, United States
Soo Kim, MD
Associate Professor
Mount Sinai Hospital
NYC, New York, United States
Abdominal Wall Myofascial Pain Syndrome
Case Description:
A 21-year-old female with no significant medical history presented with lower quadrant abdominal pain for 2 years. She described it as constant, achy, burning, pulsating, sharp, and stabbing, with associated nausea. The pain worsened with walking, standing, and climbing stairs but improved with lying down, heat, and gabapentin. Examination showed tenderness over the rectus abdominis without thoracic spine tenderness or sensory changes along the T10 dermatome.
Prior evaluation included colonoscopy, MRI spine, abdomen, pelvis, diagnostic exploratory laparoscopy, cervical biopsy, and EMG ruled out IBS, malignancy, MS, and peripheral nerve pathology. Despite no clear lesions being identified, she was diagnosed with endometriosis and recommended for hysterectomy and oophorectomy, which she declined. She was also seen at a different pain clinic and found no relief after a TAP block. Abdominal wall myofascial pain syndrome involving the left rectus abdominis was diagnosed, and she received three trigger point injections with moderate relief.
Discussions:
The differential diagnosis for unexplained abdominal pain in young, menstruating women is broad and often spans multiple specialties. Abdominal wall trigger points are rare and often overlooked, leading to unnecessary workups and treatment delays. These trigger points can cause referred pain, complicating the pain’s localization. Trigger point injections are both diagnostic and therapeutic. Early recognition of rectus abdominis trigger points is crucial to avoid unnecessary procedures. Timely intervention with trigger point injections confirms a musculoskeletal cause, reducing morbidity and healthcare costs.
Conclusions:
Abdominal wall trigger points are a rare and overlooked cause of abdominal pain. Delays in treatment frequently occur as patients undergo invasive evaluations for more common conditions. This case highlights the importance of considering myofascial pain syndromes early in the diagnostic process and the safety and utility of trigger point injections.
