Modified Infiltration Technique for Cutaneous Nerve Entrapment Syndrome

Abstract

Lateral thoracic or abdominal cutaneous nerve entrapment syndrome (C.N.E.S.) refers to the pain originating from thoracic or abdominal wall. It is a common ailment which is often misdiagnosed as arising from a source inside the abdominal cavity mistakenly leading to inappropriate diagnostic investigations, unsatisfactory treatment, and considerable costs. The thoracoabdominal nerves terminate as the cutaneous nerves at a point from which accessory branches are given off in the rectus channel ending in the skin. Peripheral nerve entrapment occurs at anatomic sites where the nerve changes direction to enter a fibrous or osseofibrous tunnel because mechanically induced irritation is most likely to occur at these locations. Controlled investigations demonstrate that satisfactory alleviation is to be gained by immediate intervention by the most widely adopted technique of a fanning infiltration of the region of maximal point of tenderness with anesthetic and anti-inflammatory agents. Unfortunately, we observe that clinicians inexperienced performing this procedure are deterred from this technique owing to fears of inaccurate medication deposition or penetrating the abdominal cavity and perforating viscera. In this paper we describe a method to provide a safe and accurately targeted injection precisely at the necessary location without risking iatrogenic harm. This is easily achieved by raising a mound of the superficial soft tissue at the point of maximal tenderness and inserting the needle oriented parallel to the surface of the anterior body surface. Adoption of this method provides a simple, safe and effective solution for C.N.E.S. and will allow recruiting more physicians to join the circle of those actively treating this condition.