Abdominal Wall Tenderness Test

00:01 This last test is one that I find to be one of the most often overlooked tests.

00:06 and it's called Carnett's sign, or the abdominal wall tenderness test.

00:11 It's designed to highlight that many patients with abdominal pain have nothing happening in their abdomen.

00:19 It's all in the abdominal wall.

00:21 And I find this to be especially true in folks who came in with nausea and vomiting, and a gastroenteritis type picture, who now have abdominal pain, but it's because they've strained the abdominal wall muscles involved in vomiting.

00:33 So we continue to examine them serially and they have continued abdominal pain and we're trying to figure out why, there's nothing going on in the abdomen, it's the abdominal wall.

00:41 So this is a great test to distinguish between intra-abdominal versus abdominal wall problems.

00:46 I'll just add that folks with, for example, abdominal cutaneous nerve entrapment syndrome, which is where one of the cutaneous nerves that perforates just lateral to the abdominal rectus muscles, they can also get in trapped and cause very focal areas of pain in the abdominal wall, that this test can help to reproduce.

01:06 So, let's say, that Shayla was telling me that she had severe pain, right here, around her epigastrium.

01:12 So, we'll start by trying to reproduce the pain that she's been having.

01:16 So, let's say, Shayla, you've been having pain, I understand right here in the epigastrium.

01:20 - Correct.

01:20 - And I'm reproducing that pain now.

01:22 Great. Now, I'd like you to sit up, and before you sit up, I want you to pay attention to whether or not, you sitting up causes more pain, less pain, or the same pain when you lift up your head and your shoulders, as if you're doing the sit-ups.

01:34 So go and do that now.

01:37 Great, now you can relax.

01:39 So, then I would say to the patient, you know, again, how did that change? So a patient who has peptic ulcer disease or active gastritis, or what have you, they're going to have pain in their abdomen, and by my pushing on it, I'm going to cause that pain.

01:53 But when she sits up, she's actually contracting the abdominal muscles that will prevent my fingers from having contact with her stomach.

02:02 So, she'll actually feel better when she sits up and contracts those muscles.

02:07 In contrast, if it's a problem with the abdominal wall musculature, as is often the case, it's going to hurt more when she contracts those sore muscles around my finger.

02:17 So, a positive Carnett's sign would be increased pain, when somebody starts to do an abdominal crunch, basically, it's a very useful exam finding.