Diagnosis
-H&P
-Typical presentation: Patient comes in with lower abd./pelvic pain. During PE, with the patient in supine, you palpate the tender area of her lower abd. When you have her raise both legs off the table while you palpate the abdomen, her pain intensifies.
-Positive Carnet Sign.
-DDx & Etiology: A hematoma within the abdominal wall musculature, etc.
Treatment
-Injection of local anesthetic and steroid (anti-inflammatory): 1ml of 1% Lidocaine PLUS 40mg of Triamcinolone mixed in the same syringe and injected into the trigger area.
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“A reduction of the pain caused by abdominal palpation when the abdominal muscles are tightened is known as Carnett’s sign. If the cause of the pain is visceral, the taut abdominal muscles may protect the locus of pain. In contrast, intensification of pain with this maneuver points to a source of pain within the abdominal wall itself.” ABFM critique.
References / Further Reading
Chronic pelvic pain in women. Am Fam Physician 2008;77(11):1535-1542.
Excellent Video on Abdominal Wall Pain.