Figure 1

Typical findings during physical examination in an ACNES patient. A. Trigger point is localized using palpating index finger. Tenderness increases when abdominal muscles are tensed as the patient lifts the head (Carnett’s test); B. Skin gnostic sensibility is determined using a swab. The shaded area overlying the trigger point reflects altered sensibility; C. A cold alcohol gauze is utilized to test the vital sensibility; D. By squeezing a fold containing the patient’s skin and subcutaneous fat between thumb and index finger, the area of interest hurts compared to the contralateral side (‘pinch test’).