Abdominal pain in quadriparesis: myofascial syndrome as unsuspected cause

This is a case report of a 47-year-old man with C6 quadriparesis who presented with tenderness in the right lower quandrant of his abdomen which was diagnosed as iliocostalis myofascial syndrome. Diagnosis of nephrolithiasis and appendicitis were considered, but the complete blood count, abdominal x-ray, intravenous pyelogram, and sonogram were all normal. His symptoms became progressively more severe over the ensuing 2-week period. Examination at that time revealed extreme tenderness to light touch in the right lower quandrant, right flank, and right posterior subcostal area. A trigger point in the right iliocostalis muscle referred pain to the right lower quandrant. In the absence of evidence of internal derangement a diagnosis of iliocostalis myofascial syndrome was made. A 3-day course of "spray and stretch" to the iliocostalis cleared the symptoms. This case illustrates that myofascial syndrome should be considered in the differential diagnosis of soft tissue pain in the patient with spinal cord injury and sensory sparing.