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Unusual Abdominal Injury
I suffered an unusual abdominal injury in late October 2014. I was following a gentle exercise program and coming up from a forward bend. My feet were hip width apart with the toes forward and the knees bent deeply to the end of the toes and pushing out to the little toes. While coming up from the forward bend in this position, I tucked the tailbone and rolled up one vertebrae at a time. While in the process of coming up to a standing position, I noticed a weird feeling in my abdomen. I picked up my shirt and noticed something sticking out about 2/3 of the length of my pinky finger to the left and slightly above my belly button. It looked like/had curvature like the Space Needle in Seattle and wiggled. Almost as soon as I noticed it, my abdominal muscles flattened back out and whatever popped out popped back in to place. It did not look like the pictures of hernias that I have seen while browsing the Internet. My abdomen and skin in that area were sore for a few days, with a slight burning sensation at the skin level in the lower left portion of the rectus abdominis/six pack area, with that particular soreness disappearing after a couple of weeks. The lower left portion of the six pack to the left and above the belly button also appeared and still appears more noticeable, leaving more of a valley between the two segments of that part of the six pack. I was able to finish the exercise program that day, although I have not done it sense, and continued an elliptical routine at the gym. I also continued to stretch after my elliptical workout but had to be more careful to avoid aggravating my abdominal muscles, particularly when doing a side-lying twist.
I had dry needling done on some trigger points in my abdominal muscles six days after the injury, which happened to be in the relative vicinity of my belly button but not where the left lower portion of the six pack appeared more noticeable. I had tried dry needling for my abdominal muscles in the past to help with a back injury, but my abdominal muscles were so rigid that the needles bent into the shape of an L. This time, the needles penetrated easily, but felt strange going into the muscle, leaving soreness and weird twitching sensations. The day after the dry needling, after getting off the elliptical, my abdominal muscles at the belly button and lower started hanging to form a pooch. I also had soreness and weird twitch sensations around where the needles were inserted, which lasted for a few months. I will occasionally get a twitching sensation now. The pooch, over the past six months, has gotten smaller. It essentially feels like an expansion in that area, creating an uncomfortable stretching sensation under the skin. It also seems to move up and down involuntarily, with the area bellow my belly button becoming firm while the area above the belly button becomes more swollen looking in appearance, all involuntarily. I am 5’11”, 140 pounds and typically appear lean with muscle tone. With the pooch, I looked pregnant. The entire muscle seemed to go flaccid overnight, though the six pack was still visible, just not firm and more rubbery feeling. I also developed prickliness and sensitivity in and around the belly button as well as sensitivity when it rubbed against a shirt.
I saw an internist, who did not find a hernia upon feeling the tender areas. I then saw a general surgeon, who did not find anything using ultrasound and checked my groin areas as well, as I had somehow severely strained my right groin on the elliptical about two weeks after the injury (I’m guessing through my body compensating). He fortunately did not find anything and did not know what happened. He said that hernias usually happen in the groin area or around the belly button, not in the area where I saw the injury, and they do not pop back in by themselves. The left side portion of the six pack is still more defined than the right side portion. I believe that this might have partially been the case before the injury. This suggests to me that the area where the injury initially occurred is still somewhat contracted, although it does not necessarily feel more contracted. The muscle also feels weird if I try to contract it, such as a movement one would do when preparing for a punch. Again, this weird contracting feeling did not happen until a week after the injury.
I saw a second internist. He felt a very tender spot in the area of the six pack where I believe the pop out occurred. The body quivered slightly when he felt the area. He thinks I saw fluid pop out, creating something looking like water shooting out of a hose, and said that it could take up to a year and a half for the nerves to heal. He thought that fluid in my abdomen created the swollen appearance, and that it would take time for the fluid to reabsorb. However, I have heard that the ultrasound would have shown fluid.
I saw another specialist who felt my abdominal area and found an extremely tender point in the left portion of the lower part of the six pack. He said that this could be a tear or small defect that has not healed properly but that he wanted to get an image of it to get a better idea. He did not seem to have any thoughts yet concerning how an injury here would connect with the aches that I have been feeling in/around my belly button (where I had been dry needled 1 week after the pop out – I did not have soreness here after the injury, only happened after the dry needling), the right groin strain, and the weird up and down movement in my abdomen that creates some flabbiness and a pooch (which also did not happen after the injury, only after the dry needling). The up and down movement of the pooch has begun to decrease and become less uncomfortable. He wants me to get an abdominal MRI without contrast, as he thinks that an MRI will show more than an ultrasound. I have not yet had the MRI. He says that the MRI will also show the thoracic spine, which will allow him to see if maybe a disc injury is causing the weirdness in my abdomen. A physical therapist checked me for spine injuries and the Beevor’s sign for injuries in the thoracic region, where the belly button would move when coming up from a supine position, and fortunately did not find anything. I have also had a treatment of a topical anti-inflammatory with ultrasound over the injured area. Everyone that I have talked to says that the dry needling would not have caused any harm. However, it seems strange to develop the majority of my current symptoms a week after the initial injury but only a day after the dry needling session. The only other thing I can think of is that worrying about the injury might have caused these additional symptoms.
I recently went back to my internist to discuss whether to get an MRI, and he says that an ultrasound is extremely accurate for diagnosing a hernia in that area. He thinks that I have a muscle/fascia injury or slight tear. He said that the mechanism is similar though not as severe as rupturing a bicep. I likely had a slight tear as opposed to a rupture, so I saw a brief bulge, and then it flattened back out when relaxed. He said that I might be more susceptible to a hernia in the future. He did not think that I had fluid buildup or injury to an internal organ, as my symptoms do not match these issues. He said that the injury could take a long time to heal. He did not think that the injury was nerve related, as that would not produce a brief bulge. He also did not think that the injury was spine related, as that would occur after a major injury with significantly more pain. He saw no need to expose myself to contrast or a CT Scan, as my issue does not warrant those tests. He did not know about pain in and around the belly button, other than nerves running from the tear. These sensations have been getting better as well over the past six months. He said that activity would not make it worse but stretching was not suggested at this point. He also thought that the injury did not look as bad as when first seen, suggesting that it is healing. The abdominal muscles are beginning to firm up again. If I try to excessively relax the abdominal muscles, I can slowly see and feel the pooch stretch out, but not as far as it did a few months ago. My groin injury has gotten significantly better over the past 6 months but is not 100% yet.
I am walking about an hour per day right now for exercise, warming up, then briskly walking, and then cooling down, but am not comfortable with anything more rigorous at this point.
Have you heard of or examined a patient with an abdominal injury of this nature? Do you have any recommendations or think that you can help me? I really do not know what else to do at this point, other than hope that the injury continues to get better and hopefully fully heal. Also, I am in Atlanta, Georgia if you have any suggestions for finding a specialist near me. One of the risks in seeking help through the Internet is receiving frightening potential issues that might or might not describe the current situation, but I have seen some very smart specialists who have not seen an injury quite like this one, and ideally, I would find someone that has treated an injury similar to mine.
Thank you for reading through this long message and taking the time to help.
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