Skip to main content
AAPM&R 2025 Main banner
JFK
Final Program


Official Program
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
On Demand
On Demand
In-Person
In-Person
Livestream
Livestream
Invite Only
Invite Only
Ticketed
Ticketed
Coffee Break
Coffee Break
Meal
Meal
Reception
Reception
Rate ePoster

Musculoskeletal and Sports Medicine

Abdominal Pain with Incidental Abdominal Intramuscular Calcification: A Case Report

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 2

    Primary Author(s)

  • Gloria Coden, MD

    PGY-2
    Washington University/B-JH/SLCH Consortium PM&R Program
    Saint Louis, Missouri

    • Co-Author(s)

  • MS

    Michael Sookochoff, MD

    Assistant professor
    Washington University/B-JH/SLCH Consortium Interventional Spine & MSK Fellowship
    St Louis, Missouri

Disclosure(s):
Gloria Coden, MD: No financial relationships to disclose
Case Diagnosis: 76-year-old male with persistent left upper quadrant abdominal pain, found to be due to musculoskeletal etiology with incidental intramuscular calcification.

Case Description or Program Description: 76-year-old male with history of bariatric surgery who presented with left-sided abdominal pain. Pain extends from the left upper quadrant down towards the bladder and radiates into the left flank. Pain is exacerbated by direct palpation, twisting, and lying flat. The patient’s bowel habits have fluctuated between constipation and diarrhea. Pain did not improve with gastrointestinal medications or after discontinuing glucagon-like peptide-1 receptor agonists. Computed tomography and endoscopy showed hiatal hernia and diverticulosis. Physical exam demonstrated tenderness to light and deep palpation over the left upper quadrant, left lower quadrant, left flank, and left back inferior to the ribcage. Nontender to palpation along the paraspinals, spinous processes, posterior pelvis, posterior superior iliac spine, sacroiliac joint, and costovertebral angle. No discomfort with FABER, FADIR, thigh thrust, logroll, and Stinchfield bilaterally.

Setting: Outpatient physical medicine and rehabilitation office at an academic medical center

Assessment/Results: Ultrasound examination of the left abdominal viscera and cavity demonstrated an intramuscular calcification just inferior to the ribs and anterior to the axillary line. Trigger point injections were performed to the left external oblique, internal oblique, transversus abdominus, rectus abdominus, and around the calcification using 1 milliliter solution of 0.2% ropivacaine and 1% lidocaine at each site, which improved symptoms.

Discussion (relevance): Abdominal and flank pain can be caused by a visceral or musculoskeletal pathology. It can be difficult to discern the underlying etiology. This case illustrates the importance of investigating musculoskeletal etiologies even if the patient is having visceral symptoms. Given this patient’s positive response to injection, it is likely that part of his pain was due to musculoskeletal etiology with incidental intramuscular calcification.

Conclusions: It is crucial to investigate both visceral and musculoskeletal etiologies of abdominal and flank pain.