John Bundrick MD has published Clinical Pearls in Internal Medicine in Mayo Clinic Proceedings, advocating Carnett maneuvers & 2% lidocaine injections for abdominal wall pain diagnosis. Yet the Surgeons of Mayo Clinic - Jacksonville & Rochester - will not do this this. They take women patients to surgery and tear up their abdominal walls removing 'neuromas.' This is not ok. The following is the discussion for Dr. Bundrick's case from Mayo Clinic Proceedings:
This case is classic for chronic abdominal wall pain, an entity first described by the British surgeon J. B. Carnett in 1926. He described the maneuver whereby the tender spot is located and then patients are asked to raise either their legs or torso (thus tensing the abdominal muscles). If the pain does not decrease (and especially if it increases) during the maneuver, then it is very unlikely to be from a visceral source and may reliably be localized to the abdominal wall muscles.
False-positive Carnett maneuvers occur infrequently (<5% or so), almost always in the setting of acute appendicitis (due to irritation of the adjacent parietal peritoneum). Chronic abdominal wall pain is typically described by the patient as being constant in nature and may worsen slightly after eating (abdominal distention) or more commonly after a bowel movement (from straining of the abdominal muscles). Obesity and depression are common comorbid conditions, as are fibromyalgia and other painful conditions.
The Carnett maneuver is not only useful in diagnosis but is also helpful in educating and reassuring patients as to the true source of their pain. Local heat or ice treatments, sometimes accompanied by gentle stretching of the abdominal muscles, have been tried with variable success. With a conservative approach, about 50% of patients will improve over several months of follow-up. Trigger point injections provide relief in about two-thirds of patients. In all cases, the diagnosis helps to provide reassurance, while avoiding unnecessary expense, testing, and confusion.
In this case, the pain is too constant and prolonged to represent biliary colic, and the elevated ALT is compatible with fatty liver. The features are not compatible with gastroesophageal reflux, and upper endoscopy did not show any gastritis or ulceration, making it unlikely that a trial of a proton pump inhibitor would be of benefit. The patient does not have atrial fibrillation and is far too young to have (and does not have the pattern to suggest) symptomatic atherosclerosis (the most common conditions associated with mesenteric ischemia).
Cases where the Mayo surgeons have removed nerves, and ripped muscles apart, have asked Mayo Clinic for repair. The surgeons will cut all the layers of abdominal muscles and remove the nerve - leaving brutal deformities. Dr. Michael Sarr, Dr. Andrew Oldenburg, and others go along with this, refuse to repair the butcheries, or even consider a Mayo Medical consult before the surgery - they rush women to surgery and cut everything up. When they can't find anything - as they forgot the Carnett's test - they remove normal nerves for pathology.
Dr. Sarr many times can't get paid for this - and continues to do this with The Legal Department's approval ie Jill Beed-Smith oks this multilation of women patients. Dr. Sarr, and probably Dr. Oldenburg, can do procedures to women patients without consent or discussion. You can add neurectomies to appendectomies, vascular procedures - anything. Mayo Clinic has no 'plan' to conserve abdominal wall nerves. Whatever Dr. Bundrick publishes - that's not what happens at Mayo Clinic.
Why are Mayo Clinic physicians unable to work together? All women patients unnecessarily surgerized for money, need to undergo repairs at Mayo Clinic expense. It's always the women as Mayo surgeons want them naked and to humiliate them.
The surgeons leave common mass closure deformities which all rupture by 3-5 years - this allows Mayo Clinic surgeons to do another surgery procedure with mesh - and further deform women patients for money. All while Dr. Bundrick publishes that his is not what happens at Mayo Clinic. When has he last done Rounds with Dr. Sarr, or checked Dr. Sarr's operative log of cases. There's piles of neurectomies, neuromas, and not a Carnett's test on the record.