Schaap Lotte, Jacobs Monica L Y E, Scheltinga Marc R M, Roumen Rudi M H
Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
Máxima Medical Centre, Department of Surgery, Eindhoven/Veldhoven, the Netherlands; SolviMáx, Centre of Expertise for ACNES, Centre of Excellence for Abdominal Wall and Groin Pain, Máxima Medical Centre, Eindhoven, the Netherlands.
Int J Surg Case Rep. 2023 Apr;105:108099. doi: 10.1016/j.ijscr.2023.108099. Epub 2023 Apr 1.
The Scratch Collapse Test (SCT) is currently used as a supportive tool diagnosing peripheral nerve neuropathies including carpal tunnel syndrome or peroneal nerve entrapment. Some patients with chronic abdominal pain suffer from entrapment of terminal branches of intercostal nerves (anterior cutaneous nerve entrapment syndrome, ACNES). ACNES is characterized by a severe disabling pain at a predictable area of the anterior abdomen. Clinical examination shows altered skin sensation and painful pinching at the area of pain. However, these findings may be subjective.
In three female patients aged 71, 33, and 43 years with suspected ACNES, the SCT was positive when scratching over the skin of the affected nerve-ending at the abdominal wall. The diagnosis ACNES was confirmed with a local abdominal wall infiltration at the tenderpoint in all three patients. In case three, the SCT turned negative after lidocaine infiltration.
ACNES was hitherto a clinical diagnosis just based on clues in medical history and physical examination. Performing a SCT in patients possibly having ACNES may additionally contribute to the diagnosis.
The SCT may serve as an additional tool for diagnosing patients with possible ACNES. A positive SCT in patients with ACNES supports the hypothesis that ACNES is indeed a peripheral neuropathy of terminal branches of the lower thoracic intercostal nerves. Controlled research is necessary to confirm the role of a SCT in ACNES.
划痕塌陷试验（SCT）目前用作诊断包括腕管综合征或腓总神经卡压在内的周围神经病变的辅助工具。一些慢性腹痛患者患有肋间神经终末支卡压（前皮神经卡压综合征，ACNES）。ACNES的特征是在前腹部可预测区域出现严重的致残性疼痛。临床检查显示疼痛区域皮肤感觉改变和压痛。然而，这些发现可能具有主观性。
在3名年龄分别为71岁、33岁和43岁的疑似ACNES女性患者中，在腹壁受影响神经末梢的皮肤上划痕时，SCT呈阳性。在所有3名患者的压痛点进行局部腹壁浸润后，ACNES诊断得到证实。在病例3中，利多卡因浸润后SCT转为阴性。
迄今为止，ACNES只是一种基于病史和体格检查线索的临床诊断。对可能患有ACNES的患者进行SCT可能有助于诊断。
SCT可作为诊断可能患有ACNES患者的辅助工具。ACNES患者SCT阳性支持ACNES确实是下胸段肋间神经终末支周围神经病变这一假说。需要进行对照研究以证实SCT在ACNES中的作用。
