1
|
Santilli O, Ostolaza M, Santilli H, Nardelli N, Etchepare H, Scaravonati R, Estevez M, Rolon A, Pascual T, Siedi A, Munafo Dauccia R, Perea A. Chronic groin pain in young sportsmen: Algorithm of assessment and treatment. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2021. [DOI: 10.4103/ijawhs.ijawhs_30_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
2
|
Abstract
A case report is presented that gives new insight into a very rare cause of athletic pubalgia. Up till now, no case has been published in literature about the relevance of an arcuate pubic ligament (APL) injury in athletic pubalgia. The APL or inferior pubic ligament is a thick triangular arch of ligamentous fibers connecting the 2 pubic bones below. The main function of the APL is to stabilize the symphysis pubis. The rupture of this ligament can lead to groin pain due to lack of stabilization of the symphysis pubis. Despite the importance of the anatomical and clinical function of the APL, very limited research is available about injuries of this ligament. This report describes a case of a traumatic left APL rupture, confirmed by magnetic resonance imaging, causing longstanding left groin pain in an amateur athlete.
Collapse
|
3
|
Prakash PS, Wijerathne S, Salgaonkar HP, Lomanto D. The efficacy of absorbable versus non-absorbable fixation in laparoscopic totally extraperitoneal (tep) repair of large inguinal hernias. Asian J Surg 2019; 42:995-1000. [DOI: 10.1016/j.asjsur.2019.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/24/2018] [Accepted: 01/24/2019] [Indexed: 01/29/2023] Open
|
4
|
Ramazzina I, Bernazzoli B, Braghieri V, Costantino C. Groin pain in athletes and non-interventional rehabilitative treatment: a systematic review. J Sports Med Phys Fitness 2018; 59:1001-1010. [PMID: 30160087 DOI: 10.23736/s0022-4707.18.08879-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Groin pain is a common complaint both in high-performance and recreational athletes. Diagnosis is based on the patient's history and physical examination. Imaging assessments are often considered to exclude other pathologies. To date there is no strong evidence to support conservative or surgical treatment options. The purpose of this study is to shed light on the more effective non-interventional rehabilitative treatments for the management of groin pain in athletes and, if possible, provide guidelines useful for clinical practice. EVIDENCE ACQUISITION The following electronic databases were searched: PubMed, Physiotherapy Evidence Database (PEDro), Scopus, Web of Science, Google and Google Scholar. Databases were investigated from January 1997 until March 2017. EVIDENCE SYNTHESIS The results reported in the randomized clinical trial studies highlight that active treatment is better than passive treatment to improve clinical signs of groin pain. Comparing the active strategy with multi-modal treatment the latter allows a faster return to sport activity. Although the evidence remains poor, all the included literature highlights that an integrated strategy which combines active and passive treatment, the assessment of perceived pain, a return to running program and specific-sport exercises is an effective strategy for management of groin pain in athletes. CONCLUSIONS Although we shed some light on common key aspects able to improve the typical signs of groin pain, on the basis of available data we were unable to provide practice guidelines. Further studies are necessary to set the best treatment algorithm for the management of groin pain in athletes.
Collapse
Affiliation(s)
- Ileana Ramazzina
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Benedetta Bernazzoli
- Graduate School of Physical Medicine and Rehabilitation, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Cosimo Costantino
- Department of Medicine and Surgery, University of Parma, Parma, Italy - .,Graduate School of Physical Medicine and Rehabilitation, Department of Medicine and Surgery, University of Parma, Parma, Italy
| |
Collapse
|
5
|
Di Pietto F, Chianca V, Zappia M, Romano S. Articular and peri-articular hip lesions in soccer players. The importance of imaging in deciding which lesions will need surgery and which can be treated conservatively? Eur J Radiol 2018; 105:227-238. [PMID: 30017285 DOI: 10.1016/j.ejrad.2018.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/02/2018] [Accepted: 06/19/2018] [Indexed: 02/08/2023]
Abstract
Soccer is one of the most popular sports worldwide engaging millions of participants each year. During play, injuries occur rather frequently and most of them involve the hip joint and the surrounding structure. In professional athletes, injuries are often complex scenarios and in the case of misdiagnosis, patients' return to play is delayed or it may progress to a more serious injury with consequent damage for their career and for the soccer team. The most frequent articular pathologies are Femoro-acetabular impingement and labral tears. Stress fracture, avulsion, ischiofemoral impingement, subspine impingement, athletic pubalgia, muscle injuries and Morel-Levallèe lesion are the most frequent hip peri-articular pathologies whereas snapping hip may be both intra- or extra-articular pathology. With an increasing number of football players, the radiologist plays a crucial role in the detection and characterization of the extent of the injuries. This article reviews the current imaging concepts frequently seen in injuries around the hips of professional football players focusing in particular on the most suitable therapeutic approaches, whether surgical or conservative.
Collapse
Affiliation(s)
- Francesco Di Pietto
- Department of Diagnostic Imaging, "A.Cardarelli" Hospital, 80131 Naples, Italy.
| | - Vito Chianca
- Department of Advanced Biomedical Sciences, Università degli Studi Federico II, Via Pansini 5, 80131 Naples, Italy.
| | - Marcello Zappia
- Department of Medicine and Health Sciences, Università del Molise, Campobasso, Italy, Via De Sanctis 1, 86100, Campobasso, Italy.
| | - Stefania Romano
- Department of Diagnostic Imaging, "A.Cardarelli" Hospital, 80131 Naples, Italy.
| |
Collapse
|
6
|
Vasileff WK, Nekhline M, Kolowich PA, Talpos GB, Eyler WR, van Holsbeeck M. Inguinal Hernia in Athletes: Role of Dynamic Ultrasound. Sports Health 2017; 9:414-421. [PMID: 28732177 PMCID: PMC5582701 DOI: 10.1177/1941738117717009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Inguinal hernia is a commonly encountered cause of pain in athletes. Because of the anatomic complexity, lack of standard imaging, and the dynamic condition, there is no unified opinion explaining its underlying pathology. Hypothesis: Athletes with persistent groin pain would have a high prevalence of inguinal hernia with dynamic ultrasound, and herniorrhaphy would successfully return athletes to activity. Study Design: Case-control study. Level of Evidence: Level 3. Methods: Forty-seven amateur and professional athletes with sports-related groin pain who underwent ultrasound were selected based on history and examination. Patients with prior groin surgery or hip pathology were excluded. Clinical and surgical documentation were correlated with imaging. The study group was compared with 41 age-matched asymptomatic athletes. Results: Ultrasound was positive for hernia with movement of bowel, bladder, or omental tissue anterior to the inferior epigastric vessels during Valsalva maneuver. The 47-patient symptomatic study group included 41 patients with direct inguinal hernias, 1 with indirect inguinal hernia, and 5 with negative ultrasound. Of 42 patients with hernia, 39 significantly improved with herniorrhaphy, 2 failed to improve after surgery and were diagnosed with adductor longus tears, and 1 improved with physical therapy. Five patients with negative ultrasound underwent magnetic resonance imaging and were diagnosed with hip labral tear or osteitis pubis. The 41-patient asymptomatic control group included 3 patients with direct inguinal hernias, 2 with indirect inguinal hernias, and 3 with femoral hernias. Conclusion: Inguinal hernias are a major component of groin pain in athletes. Prevalence of direct inguinal hernia in symptomatic athletes was greater than that for controls (P < 0.001). Surgery was successful in returning these athletes to sport: 39 of 42 (93%) athletes with groin pain and inguinal hernia became asymptomatic. Clinical Relevance: Persistent groin pain in the athlete may relate to inguinal hernia, which can be diagnosed with dynamic ultrasound imaging. Herniorrhaphy is successful at returning athletes to sports activity.
Collapse
Affiliation(s)
| | | | | | - Gary B Talpos
- Department of Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Willam R Eyler
- Department of Radiology, Henry Ford Hospital, Detroit, Michigan
| | | |
Collapse
|
7
|
Abstract
Historically, athletic hip injuries have garnered little attention; however, these injuries account for approximately 6% of all sports injuries and their prevalence is increasing. At times, the diagnosis and management of hip injuries can be challenging and elusive for the team physician. Hip injuries are seen in high-level athletes who participate in cutting and pivoting sports that require rapid acceleration and deceleration. Described previously as the "sports hip triad," these injuries consist of adductor strains, osteitis pubis, athletic pubalgia, or core muscle injury, often with underlying range-of-motion limitations secondary to femoroacetabular impingement. These disorders can happen in isolation but frequently occur in combination. To add to the diagnostic challenge, numerous intra-articular disorders and extra-articular soft-tissue restraints about the hip can serve as pain generators, in addition to referred pain from the lumbar spine, bowel, bladder, and reproductive organs. Athletic hip conditions can be debilitating and often require a timely diagnosis to provide appropriate intervention.
Collapse
|
8
|
Popkin CA, Schulz BM, Park CN, Bottiglieri TS, Lynch TS. Evaluation, management and prevention of lower extremity youth ice hockey injuries. Open Access J Sports Med 2016; 7:167-176. [PMID: 27920584 PMCID: PMC5123732 DOI: 10.2147/oajsm.s118595] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Ice hockey is a fast-paced sport played by increasing numbers of children and adolescents in North America and around the world. Requiring a unique blend of skill, finesse, power and teamwork, ice hockey can become a lifelong recreational activity. Despite the rising popularity of the sport, there is ongoing concern about the high frequency of musculoskeletal injury associated with participation in ice hockey. Injury rates in ice hockey are among the highest in all competitive sports. Numerous research studies have been implemented to better understand the risks of injury. As a result, rule changes were adopted by the USA Hockey and Hockey Canada to raise the minimum age at which body checking is permitted to 13–14 years (Bantam level) from 11–12 years (Pee Wee). Continuing the education of coaches, parents and players on rules of safe play, and emphasizing the standards for proper equipment use are other strategies being implemented to make the game safer to play. The objective of this article was to review the evaluation, management and prevention of common lower extremity youth hockey injuries.
Collapse
Affiliation(s)
- Charles A Popkin
- Department of Orthopedic Surgery, Center for Shoulder, Elbow and Sports Medicine at Columbia University, New York, NY
| | | | - Caroline N Park
- Department of Orthopedic Surgery, Center for Shoulder, Elbow and Sports Medicine at Columbia University, New York, NY
| | - Thomas S Bottiglieri
- Department of Orthopedic Surgery, Center for Shoulder, Elbow and Sports Medicine at Columbia University, New York, NY
| | - T Sean Lynch
- Department of Orthopedic Surgery, Center for Shoulder, Elbow and Sports Medicine at Columbia University, New York, NY
| |
Collapse
|
9
|
Choi HR, Elattar O, Dills VD, Busconi B. Return to Play After Sports Hernia Surgery. Clin Sports Med 2016; 35:621-36. [DOI: 10.1016/j.csm.2016.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
10
|
Abstract
Context: Groin pain is a common entity in athletes involved in sports that require acute cutting, pivoting, or kicking such as soccer and ice hockey. Athletic pubalgia is increasingly recognized as a common cause of chronic groin and adductor pain in athletes. It is considered an overuse injury predisposing to disruption of the rectus tendon insertion to the pubis and weakness of the posterior inguinal wall without a clinically detectable hernia. These patients often require surgical therapy after failure of nonoperative measures. A variety of surgical options have been used, and most patients improve and return to high-level competition. Evidence Acquisition: PubMed databases were searched to identify relevant scientific and review articles from January 1920 to January 2015 using the search terms groin pain, sports hernia, athletic pubalgia, adductor strain, osteitis pubis, stress fractures, femoroacetabular impingement, and labral tears. Study Design: Clinical review. Level of Evidence: Level 4. Results and Conclusion: Athletic pubalgia is an overuse injury involving a weakness in the rectus abdominis insertion or posterior inguinal wall of the lower abdomen caused by acute or repetitive injury of the structure. A variety of surgical options have been reported with successful outcomes, with high rates of return to the sport in the majority of cases.
Collapse
Affiliation(s)
- Osama Elattar
- Orthopaedic Sports Medicine, University of Massachusetts, Worcester, Massachusetts
| | - Ho-Rim Choi
- Orthopaedic Sports Medicine, University of Massachusetts, Worcester, Massachusetts
| | - Vickie D Dills
- Director of Clinical Services, Physical Therapy Innovations, Auburn, Massachusetts
| | - Brian Busconi
- Orthopaedic Sports Medicine, University of Massachusetts, Worcester, Massachusetts
| |
Collapse
|
11
|
Munegato D, Bigoni M, Gridavilla G, Olmi S, Cesana G, Zatti G. Sports hernia and femoroacetabular impingement in athletes: A systematic review. World J Clin Cases 2015; 3:823-830. [PMID: 26380829 PMCID: PMC4568531 DOI: 10.12998/wjcc.v3.i9.823] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 04/02/2015] [Accepted: 07/08/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To investigate the association between sports hernias and femoroacetabular impingement (FAI) in athletes.
METHODS: PubMed, MEDLINE, CINAHL, Embase, Cochrane Controlled Trials Register, and Google Scholar databases were electronically searched for articles relating to sports hernia, athletic pubalgia, groin pain, long-standing adductor-related groin pain, Gilmore groin, adductor pain syndrome, and FAI. The initial search identified 196 studies, of which only articles reporting on the association of sports hernia and FAI or laparoscopic treatment of sports hernia were selected for systematic review. Finally, 24 studies were reviewed to evaluate the prevalence of FAI in cases of sports hernia and examine treatment outcomes and evidence for a common underlying pathogenic mechanism.
RESULTS: FAI has been reported in as few as 12% to as high as 94% of patients with sports hernias, athletic pubalgia or adductor-related groin pain. Cam-type impingement is proposed to lead to increased symphyseal motion with overload on the surrounding extra-articular structures and muscle, which can result in the development of sports hernia and athletic pubalgia. Laparoscopic repair of sports hernias, via either the transabdominal preperitoneal or extraperitoneal approach, has a high success rate and earlier recovery of full sports activity compared to open surgery or conservative treatment. For patients with FAI and sports hernia, the surgical management of both pathologies is more effective than sports pubalgia treatment or hip arthroscopy alone (89% vs 33% of cases). As sports hernias and FAI are typically treated by general and orthopedic surgeons, respectively, a multidisciplinary approach for diagnosis and treatment is recommended for optimal treatment of patients with these injuries.
CONCLUSION: The restriction in range of motion due to FAI likely contributes to sports hernias; therefore, surgical treatment of both pathologies represents an optimal therapy.
Collapse
|
12
|
Paksoy M, Sekmen Ü. Sportsman hernia; the review of current diagnosis and treatment modalities. ULUSAL CERRAHI DERGISI 2015; 32:122-9. [PMID: 27436937 DOI: 10.5152/ucd.2015.3132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 04/12/2015] [Indexed: 11/22/2022]
Abstract
Groin pain is an important clinical entity that may affect a sportsman's active sports life. Sportsman's hernia is a chronic low abdominal and groin pain syndrome. Open and laparoscopic surgical treatment may be chosen in case of conservative treatment failure. Studies on sportsman's hernia, which is a challenging situation in both diagnosis and treatment, are ongoing in many centers. We reviewed the treatment results of 37 patients diagnosed and treated as sportsman's hernia at our hospital between 2011-2014, in light of current literature.
Collapse
Affiliation(s)
- Melih Paksoy
- Department of General Surgery, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Ümit Sekmen
- Clinic of General Surgery, Acıbadem Fulya Hospital, İstanbul, Turkey
| |
Collapse
|
13
|
Ultrasound-guided Corticosteroid Injection for the Treatment of Athletic Pubalgia: A Series of 12 Cases. J Med Ultrasound 2015. [DOI: 10.1016/j.jmu.2014.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
14
|
Sports hernias: experience in a sports medicine center. Hernia 2015; 20:77-84. [PMID: 25784289 DOI: 10.1007/s10029-015-1367-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 03/08/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Chronic pain of the inguino-crural region or "pubalgia" explains the 0.5-6.2% of the consultations by athletes. Recently, areas of weakness in the posterior wall called "sports hernias," have been identified in some of these patients, capable of producing long-standing pain. Several authors use different image methods (CT, MRI, ultrasound) to identify the lesion and various techniques of repair, by open or laparoscopic approaches, have been proposed but there is no evidence about the superiority of one over others due to the difficulty for randomizing these patients. In our experience, diagnosis was based on clinical and ultrasound findings followed by laparoscopic exploration to confirm and repair the injury. The present study aims to assess the performance of our diagnostic and therapeutic management in a series of athletes affected by "pubalgia". METHODS 1450 athletes coming from the orthopedic office of a sport medicine center were evaluated. In 590 of them (414 amateur and 176 professionals) sports hernias were diagnosed through physical examination and ultrasound. We performed laparoscopic "TAPP" repair and, thirty days after, an assessment was performed to determine the evolution of pain and the degree of physical activity as a sign of the functional outcome. We used the U Mann-Whitney test for continuous scale variables and the chi-square test for dichotomous variables with p < 0.05 as a level of significance. RESULTS In 573 patients ultrasound examination detected some protrusion of the posterior wall with normal or minimally dilated inguinal rings, which in 498 of them coincided with areas affected by pain. These findings were confirmed by laparoscopic exploration that also diagnosed associated contralateral (30.1%) and ipsilateral defects, resulting in a total of 1006 hernias. We found 84 "sport hernias" in 769 patients with previous diagnosis of adductor muscle strain (10.92%); on the other hand, in 127 (21.52%) of our patients with "sport hernias" US detected concomitant injuries of the adductor longus tendon, 7 of which merited additional surgical maneuvers (partial tenotomy). Compared with the findings of laparoscopy, ultrasound had a sensitivity of 95.42% and a specificity of 100%; the positive and negative predictive values were 100 and 99.4% respectively. No postoperative complications were reported. Only seven patients suffered recurrence of pain (successful rate: 98.81%); the ultrasound ruled out hernia recurrence, but in three cases it diagnosed tendinitis of the rectus abdominis muscle. CONCLUSIONS Our series reflects the multidisciplinary approach performed in a sports medicine center in which patients are initially evaluated by orthopedic surgeons in order to discard the most common causes of "pubalgia". "Sports hernias" are often associated with adductor muscle strains and other injuries of the groin allowing speculate that these respond to a common mechanism of production. We believe that, considering the difficulty to design randomized trials, only a high coincidence among the diagnostic and therapeutic instances can ensure a rational health care.
Collapse
|
15
|
A literature review on the role of totally extraperitoneal repairs for groin pain in athletes. Int Surg 2014; 97:327-34. [PMID: 23294074 DOI: 10.9738/cc156.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
A literature review was made on the role of totally extraperitoneal (TEP) hernia repairs for groin pain in athletes. Electronic databases were searched for literature published from January 1993 to November 2011. There were 10 articles incorporating 196 patients included in this review. Thirty percent of patients were reported to have direct inguinal hernias, 22% had indirect inguinal hernias, and 41% had dilated internal rings. Of note, 30% of cases had no macroscopic abnormality. Four studies reported on an early follow-up ranging between 3 and 6 weeks. Only minimal or mild symptoms were reported. Up to 33% of patients had impaired ability to perform at peak levels. Up to 53% of patients had persistence of symptoms at the early follow-up. Total follow-up time ranged from 3 to 80 months, and most patients were active (90%-100%). At long-term follow-up, 3% to 10% were unable to play, and 5% were reported as being unable to train. Two studies from the same center reported on TEP surgery for osteitis pubis, and most patients returned to sporting activity after 4 to 8 weeks. TEP repair is a good operative intervention in athletes with chronic groin pain not relieved by conservative measures. Athletes recover quickly and return to sport early.
Collapse
|
16
|
Economopoulos KJ, Milewski MD, Hanks JB, Hart JM, Diduch DR. Radiographic evidence of femoroacetabular impingement in athletes with athletic pubalgia. Sports Health 2014; 6:171-7. [PMID: 24587869 PMCID: PMC3931339 DOI: 10.1177/1941738113510857] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background: Two of the most common causes of groin pain in athletes are femoroacetabular impingement (FAI) and athletic pubalgia. An association between the 2 is apparent, but the prevalence of radiographic signs of FAI in patients undergoing athletic pubalgia surgery remains unknown. The purpose of this study was to determine the prevalence of radiologic signs of FAI in patients with athletic pubalgia. Hypothesis: We hypothesized that patients with athletic pubalgia would have a high prevalence of underlying FAI. Study Design: Case series. Level of Evidence: Level 4. Methods: A retrospective review of all patients evaluated at our institution with athletic pubalgia who underwent surgical treatment (ie, for sports hernia) from 1999 to 2011 was performed. The radiographs of patients with athletic pubalgia were reviewed for radiographic signs of FAI. Alpha angles were measured using frog-leg lateral radiographs. Pincer lesions were identified by measuring the lateral center-edge angle and identifying the presence of a “crossover” sign on anteroposterior radiographs. Phone follow-up was performed 2 years or more after the initial sports hernia surgery to evaluate recurrent symptoms. Results: Forty-three patients underwent 56 athletic pubalgia surgeries. Radiographic evidence of FAI was identified in at least 1 hip in 37 of 43 patients (86%). Cam lesions were identified in 83.7% of the population; the alpha angle averaged 66.7° ± 17.9° for all hips. Pincer lesions were present in 28% of the hips. Eight patients had recurrent groin pain, 3 patients had revision athletic pubalgia surgery, and 1 had hip arthroscopy. Conclusion: The study demonstrates a high prevalence of radiographic FAI in patients with athletic pubalgia. Clinical Relevance: Underlying FAI may be a cause of continued groin pain after athletic pubalgia surgery. Patients with athletic pubalgia should be evaluated closely for FAI.
Collapse
Affiliation(s)
| | - Matthew D Milewski
- Elite Sports Medicine, Connecticut Children's Medical Center, Farmington, Connecticut
| | - John B Hanks
- Department of General Surgery, University of Virginia, Charlottesville, Virginia
| | - Joseph M Hart
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - David R Diduch
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| |
Collapse
|
17
|
Jagtap P, Shetty G, Mane P, Shetty V. Emerging intra-articular causes of groin pain in athletes. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:1331-9. [PMID: 24101188 DOI: 10.1007/s00590-013-1325-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 09/24/2013] [Indexed: 11/25/2022]
Abstract
Groin pain remains one of the most poorly understood conditions in clinical sports medicine. It may be caused by either extra-articular or intra-articular conditions. While extra-articular causes have been extensively studied and reasonably understood, a number of elusive intra-articular causes are emerging, many of which were previously unknown and therefore undiagnosed, leading to premature ending of many competitive careers. This article makes an attempt to look at various, elusive intra-articular causes of groin pain in athletes. This article also analyses the currently available evidence on trends in diagnosis and treatment for these conditions.
Collapse
Affiliation(s)
- Prajyot Jagtap
- Hiranandani Orthopaedic Medical Education (HOME), Dr. L. H. Hiranandani Hospital, Hillside Avenue, Hiranandani Gardens, Powai, Mumbai, 400076, India
| | | | | | | |
Collapse
|
18
|
Murphy G, Foran P, Murphy D, Tobin O, Moynagh M, Eustace S. "Superior cleft sign" as a marker of rectus abdominus/adductor longus tear in patients with suspected sportsman's hernia. Skeletal Radiol 2013; 42:819-25. [PMID: 23354527 DOI: 10.1007/s00256-013-1573-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 10/09/2012] [Accepted: 01/06/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We describe a new imaging sign, the "superior cleft sign", identified at both symphysography and MRI, which should be used as a marker of rectus abdominis/adductor longus attachment tearing. MATERIALS AND METHODS A study population of 25 patients presenting with clinically suspected sportsman's hernia, who had undergone both symphysography and MRI of the groin were included for study. In each case, images were reviewed to determine the presence of a superior cleft, secondary cleft, and or both abnormalities. RESULTS Images of all patients complaining of groin crease discomfort similar to sportsman's hernia revealed the presence of a superior cleft at the rectus abdominis/adductor longus attachment. This "superior cleft sign" correlated with the side of symptoms in each case, and, in contrast to the previously described secondary cleft along the inferior margin of the inferior pubic ramus, occurred parallel to the inferior margin of the superior pubic ramus. CONCLUSIONS The presence of the "superior cleft sign" should be sought in addition to the previously described secondary cleft sign in sportspeople presenting with exercise-related groin pain or pubalgia. It should specifically be sought in patients referred with suspected sportsman's hernia.
Collapse
Affiliation(s)
- Grainne Murphy
- Radiology Department, Cappagh National Orthopaedic Hospital, Cappagh Road, Finglas, Dublin 11, Ireland.
| | | | | | | | | | | |
Collapse
|
19
|
|
20
|
Maffulli N, Loppini M, Longo UG, Denaro V. Bilateral mini-invasive adductor tenotomy for the management of chronic unilateral adductor longus tendinopathy in athletes. Am J Sports Med 2012; 40:1880-6. [PMID: 22707750 DOI: 10.1177/0363546512448364] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND To date, the best management of chronic groin pain related to adductor longus tendinopathy has not been defined. Although there have been some studies investigating the effectiveness of adductor longus tenotomy, none have investigated bilateral adductor tenotomy for unilateral tendinopathy. HYPOTHESIS The use of bilateral percutaneous adductor tenotomy for the management of chronic unilateral groin pain as a result of adductor longus tendinopathy will result in improvement of overall function and facilitate a return to athletic activity. STUDY DESIGN Case series; Level of evidence, 4. METHODS During the period from 2004 to 2007, we prospectively enrolled 29 consecutive athletes (26 male and 3 female; median age, 28 years) with chronic groin pain from unilateral adductor longus tendinopathy who underwent bilateral adductor tenotomy. Functional outcome and health status were assessed with the Hip Disability and Osteoarthritis Outcome Score (HOOS), Short Form Health Survey (SF-36), and European Quality of Life-5 Dimensions scale (EQ-5D). The ability to participate in sport before and after surgery and the time to return to training and return to sport were also recorded. The median follow-up after surgery was 36 months. RESULTS All questionnaires showed a statistically significant improvement (P < .0001) after surgery. At the time of latest follow-up, 20 of 29 patients (69%) returned to their preinjury level of sport and 2 of 29 patients (7%) to higher levels compared with preinjury status. However, 4 of 29 patients (14%) returned to sport at lower levels than those of preinjury status, and 3 of 29 patients (10%) ceased to participate in sport. The median time to return to training was 11 weeks and to return to sport was 18 weeks. CONCLUSION Bilateral mini-invasive adductor tenotomy can be an effective treatment for athletes suffering from unilateral chronic groin pain associated with adductor longus tendinopathy refractory to nonoperative management.
Collapse
Affiliation(s)
- Nicola Maffulli
- Orth Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London E1 4DG, United Kingdom.
| | | | | | | |
Collapse
|
21
|
Yuill EA, Pajaczkowski JA, Howitt SD. Conservative care of sports hernias within soccer players: a case series. J Bodyw Mov Ther 2012; 16:540-8. [PMID: 23036885 DOI: 10.1016/j.jbmt.2012.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 03/28/2012] [Accepted: 04/03/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To detail the progress of 2 high-level soccer players and 1 recreational soccer player with chronic groin pain that was exacerbated by participation in sports and relieved by rest. The patients under went a conservative treatment plan featuring manual therapy, therapeutic modalities, and plyometric training. CLINICAL FEATURES The most important examination findings were palpable tenderness over the internal oblique fascia and anterior pubic tubercle, pain with resisted hip adduction, and pain with a resisted abdominal curl-up. Conventional treatment aimed at decreasing healing time of the injury through manual therapy, including soft tissue and modality techniques; rehabilitative exercises, focusing on the pelvic muscles; and plyometric training, aiming at sport specific functional improvement. INTERVENTION The conservative treatment approach utilized in this case series involved manual therapy, 1-2 times a week for 6-8 weeks, consisting of soft tissue, laser, microcurrent, and acupuncture; rehabilitative exercise and plyometric training, 3 times a week for 8 weeks, to help improve strength, coordination, and correct pelvic muscle imbalances. Outcome measures included visual analog scale scores and resisted muscle testing. SUMMARY Three soccer players, of varying levels of ability, presenting with a suspected sports hernia (chronic groin pain exacerbated by sports and relieved by rest) were relieved of their pain after 8 weeks of conservative care featuring manual therapy, rehabilitative exercises, and plyometric training.
Collapse
Affiliation(s)
- Erik A Yuill
- Sports Science Resident, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario M2H 3J1, Canada.
| | | | | |
Collapse
|
22
|
Meyers WC, Yoo E, Devon ON, Jain N, Horner M, Lauencin C, Zoga A. Understanding “Sports Hernia” (Athletic Pubalgia): The Anatomic and Pathophysiologic Basis for Abdominal and Groin Pain in Athletes. OPER TECHN SPORT MED 2012. [DOI: 10.1053/j.otsm.2012.03.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
23
|
Bátorfi J, Simon E, Parti K, Horváth A, Bajsz A, Horváth T. [Occult inguinal-hernia in athletes]. Magy Seb 2012; 65:14-8. [PMID: 22343101 DOI: 10.1556/maseb.65.2012.1.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The occult inguinal hernia in athletes represents a distinct entity as well as a part of a syndrome known as PIPS (public inguinal pain syndrome). It may be relatively difficult to identify the possible source of inguinal pain, since the spectrum is so wide that it can overlap various medical subspecialties. PATIENTS AND METHODS This study includes 14 cases of athletes (11 football players) with suspicion of occult inguinal hernia. All of them complained of suprapubic pain on physical activity which was relieved at rest. No hernia was found on physical examination in either patient. Ultrasonography of the region demonstrated protrusion of the posterior abdominal wall by increased intraabdominal pressure (such as coughing) in 12 cases. Diagnostic laparoscopy was performed in every case, and we found 13 medial and 1 femoral hernia, i.e. a hernia was identified in all patients. Laparoscopic hernia repair with TAPP (transabdominal preperitoneal) technique was carried out in every case. RESULTS Patients were discharged 2-3 days after surgery without any postoperative complication. A gradual increase in physical activity was advised up to the limit of complaints commencing 7-10 days later. All patients could return to competitive sports after 4-6 weeks. CONCLUSION Differential diagnosis of inguinal pain in athletes includes occult inguinal hernia, which can be diagnosed with laparoscopy and TAPP repair can be carried out at the same time, if needed, to fix it.
Collapse
Affiliation(s)
- József Bátorfi
- Nagykanizsa Megyei Jogú Város Kórháza, Általános Sebészeti Osztály, Nagykanizsa Szekeres.
| | | | | | | | | | | |
Collapse
|
24
|
Mullens FE, Zoga AC, Morrison WB, Meyers WC. Review of MRI technique and imaging findings in athletic pubalgia and the "sports hernia". Eur J Radiol 2011; 81:3780-92. [PMID: 21893391 DOI: 10.1016/j.ejrad.2011.03.100] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 03/22/2011] [Indexed: 11/28/2022]
Abstract
The clinical syndrome of athletic pubalgia has prematurely ended many promising athletic careers, has made many active, fitness conscious adults more sedentary, and has served as a diagnostic and therapeutic conundrum for innumerable trainers and physicians worldwide for decades. This diagnosis actually arises from one or more lesions within a spectrum of musculoskeletal and visceral injuries. In recent years, MRI has helped define many of these syndromes, and has proven to be both sensitive and specific for numerous potential causes of athletic pubalgia. This text will provide a comprehensive, up to date review of expected and sometimes unexpected MRI findings in the setting of athletic pubalgia, and will delineate an imaging algorithm and MRI protocol to help guide radiologists and other clinicians dealing with refractory, activity related groin pain in an otherwise young, healthy patient. There is still more to be learned about prevention and treatment plans for athletic pubalgia lesions, but accurate diagnosis should be much less nebulous and difficult with the use of MRI as a primary imaging modality.
Collapse
Affiliation(s)
- Frank E Mullens
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | | |
Collapse
|
25
|
Minnich JM, Hanks JB, Muschaweck U, Brunt LM, Diduch DR. Sports hernia: diagnosis and treatment highlighting a minimal repair surgical technique. Am J Sports Med 2011; 39:1341-9. [PMID: 21505079 DOI: 10.1177/0363546511402807] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Groin injuries are a common occurrence in elite-level athletes. These injuries can cause significant pain and disability, leading to prolonged periods of inactivity and consternation among athletes, coaches, athletic trainers, and physicians alike. The differential diagnosis for groin pain is vast and spans multiple disciplines, including orthopaedics, general surgery, urology, gynecology, and neurology. Sports hernias are one cause of chronic groin pain in athletes and are distinct entities from classic hernias. They are often caused by a deficient posterior wall of the inguinal canal, but may also involve concurrent injuries, such as conjoint and adductor tendinopathies and nerve entrapment. Understanding the complex lower abdominal, pelvic, and hip anatomy and pathophysiology of sports hernias is crucial to making an accurate diagnosis and providing appropriate treatment options. Newer, less invasive surgical repair techniques show promising early results in improving pain and decreasing recovery time.
Collapse
Affiliation(s)
- John M Minnich
- University of Virginia, Department of Orthopaedic Surgery, Charlottesville, VA, USA
| | | | | | | | | |
Collapse
|
26
|
Rassner L. Lumbar plexus nerve entrapment syndromes as a cause of groin pain in athletes. Curr Sports Med Rep 2011; 10:115-20. [PMID: 21623294 DOI: 10.1249/jsr.0b013e318214a045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In athletes, groin pain is not uncommon and can be severe and activity-limiting. Nerve entrapment syndromes of the lumbar plexus are a rare but important etiology that should be considered when evaluating athletes. Diagnosis can be made based on patterns of pain and hypoesthesia following the sensory distribution of the involved nerve and by pain relief with nerve block. Conservative therapies, including nerve blocks, neurodestructive procedures, and medications, may provide long-term pain relief. If nonsurgical therapies fail, referral should be made for surgical exploration and neurectomy.
Collapse
Affiliation(s)
- Leslie Rassner
- St. Mark's Family Medicine, Salt Lake City, UT 84124, USA.
| |
Collapse
|
27
|
|
28
|
Jarosz BS. Individualized multi-modal management of osteitis pubis in an Australian Rules footballer. J Chiropr Med 2011; 10:105-10. [PMID: 22014865 DOI: 10.1016/j.jcm.2010.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 09/05/2010] [Accepted: 09/07/2010] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE The purpose of this case report is to describe and discuss the successful management of osteitis pubis in a semi-elite Australian Rules football player through the utilization of an individualized multi-modal treatment approach provided by a chiropractor. CLINICAL FEATURES A 20-year-old male semi-elite Australian Rules football player presented to a chiropractic clinic with groin pain of eight months duration. A clinical diagnosis of osteitis pubis was made through synthesis of the patient history and physical examination. INTERVENTION AND OUTCOME Treatment consisted of high velocity low amplitude spinal manipulative therapy, mechanically assisted adjusting techniques utilizing a hand-held mechanical thrusting instrument and drop piece table, myofascial release and active release soft tissue techniques, proprioceptive neuromuscular facilitation stretching, and an individually designed rehabilitation program. Resolution of signs and symptoms occurred over four weeks. No recurrence of injury was reported over a six-month period. CONCLUSIONS This case suggests that the implementation of an individualized multi-modal management approach directed specifically toward an athlete's deficiencies and requirements, may lead to a more rapid recovery from osteitis pubis.
Collapse
|
29
|
Litwin DE, Sneider EB, McEnaney PM, Busconi BD. Athletic Pubalgia (Sports Hernia). Clin Sports Med 2011; 30:417-34. [DOI: 10.1016/j.csm.2010.12.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
30
|
Silvis ML, Mosher TJ, Smetana BS, Chinchilli VM, Flemming DJ, Walker EA, Black KP. High prevalence of pelvic and hip magnetic resonance imaging findings in asymptomatic collegiate and professional hockey players. Am J Sports Med 2011; 39:715-21. [PMID: 21233405 DOI: 10.1177/0363546510388931] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Prior retrospective studies have reported magnetic resonance imaging (MRI) findings of common adductor-abdominal rectus enthesopathy and acetabular labral tear in athletes treated for athletic pubalgia and hip pain. The true prevalence of these findings and association with symptoms in this population is unknown. PURPOSE This study was undertaken to determine the prevalence of pelvic and hip MRI findings and association with clinical symptoms in professional and collegiate hockey players. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS The study included 21 professional and 18 collegiate hockey players. Self-reported symptoms were measured using a modified Oswestry Disability Questionnaire. Participants underwent 3-T MRI evaluation of the pelvis and hips. The MRI scans were interpreted independently by 3 musculoskeletal radiologists in 2 sessions separated by 3 months using a 5-point Likert scale to assess for features associated with common adductor-abdominal rectus dysfunction and hip pathology. To estimate prevalence, MRI findings rated 4 or higher on 4 of the 6 interpretations were considered positive. A variance component analysis was applied to determine intrareader and interreader reliability and the lower 95% confidence limits (CLs). RESULTS No participants reported symptoms related to pelvic or hip disorders. The MRI findings of common adductor-abdominal rectus dysfunction were observed in 14 of 39 participants (36%) and hip pathologic changes in 25 of 39 (64%). There was moderate agreement between readings, with intrareader and interreader reliabilities ranging from 0.37 to 1.00. The interreader reliability was less for evaluation of hip pathologic abnormalities than for groin pathologic abnormalities, with the lowest reliability observed in reporting of hip osteochondral lesions (0.37 with lower 95% CL of 0.22) and fluid in the primary cleft (0.45 with lower 95% CL of 0.29) and perfect reliability in the absence of effusion and abdominal rectus tendon tears. Overall, 30 of 39 (77%) asymptomatic hockey players demonstrated MRI findings of hip or groin pathologic abnormalities. CONCLUSION Given the high prevalence of MRI findings in asymptomatic hockey players, it is necessary to cautiously interpret the significance of these findings in association with clinical presentation. Future investigations will determine whether these asymptomatic findings predict future disabilities.
Collapse
Affiliation(s)
- Matthew L Silvis
- Pennsylvania State Milton S. Hershey Medical Center, 17033, USA.
| | | | | | | | | | | | | |
Collapse
|
31
|
|
32
|
|
33
|
Adductor tenotomy: its role in the management of sports-related chronic groin pain. Arch Orthop Trauma Surg 2010; 130:965-70. [PMID: PMID: 20033698 DOI: 10.1007/s00402-009-1032-4] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Indexed: 02/09/2023]
Abstract
PATIENTS AND METHODS Chronic adductor-related groin pain in athletes is debilitating and is often challenging to treat. Little is published on the surgical treatment when conservative measures fail. This single center study reviews the outcomes of 48 patients (68 groins) who underwent percutaneous adductor tenotomy for sports-related chronic groin pain. Questionnaire assessments were made preoperatively and at a minimum follow-up of 25 months. RESULTS Mean pre-injury Tegner activity scores of 8.8 reduced to 6.1 post-injury and these improved to 7.7 following surgery (p < 0.001). Sixty percent of patients regained or bettered their pre-injury Tegner activity scores after the adductor surgery; however, mean post-surgical Tegner scores still remained lower than pre-injury scores (p < 0.001). No patient had been able to engage in their chosen sport at their full ability pre-operatively, and 40% had been unable to participate in any sporting activity. The mean return to sports was at 18.5 weeks postoperatively, with 54% returning to their pre-injury activity levels, and only 8% still unable to perform athletic activities at latest follow-up. Seventy-three percent patients rated the outcome of their surgery as excellent or very satisfactory, and only three patients would not have wished to undergo the procedure again if symptoms recurred or developed on the opposite side. No patients reported their outcome as worse. A 78.1% mean improvement in function and an 86.5% mean improvement in pain were reported, and these two measures showed statistically significant correlation (p = 0.01). Groin disability scores improved from a mean of 11.8 to 3.9, post-operatively (p < 0.001). Bruising was seen in 37% of procedures, 3 patients developed a scrotal hematoma and 1 patient had a superficial wound infection. One patient developed recurrent symptoms following re-injury 26 months post-surgery, and fully recovered following a further adductor tenotomy. CONCLUSIONS Adductor tenotomy provides good symptomatic and functional improvement in chronic adductor-related groin pain refractory to conservative treatment.
Collapse
|
34
|
Waryasz GR. Exercise Strategies to Prevent the Development of the Anterior Pelvic Tilt: Implications for Possible Prevention of Sports Hernias and Osteitis Pubis. Strength Cond J 2010. [DOI: 10.1519/ssc.0b013e3181d58aac] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
35
|
Garvey JFW, Read JW, Turner A. Sportsman hernia: what can we do? Hernia 2010; 14:17-25. [PMID: 20066552 DOI: 10.1007/s10029-009-0611-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 12/08/2009] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Sportsman (sports) hernia is a medially located bulge in the posterior wall of the inguinal canal that is common in football players. About 90% of cases occur in males. The injury is also found in the general population. CLINICAL PRESENTATION The presenting symptom is chronic groin pain which develops during exercise, aggravated by sudden movements, accompanied by subtle physical examination findings and a medial inguinal bulge on ultrasound. Pain persists after a game, abates during a period of lay-off, but returns on the resumption of sport. Frequently, sports hernia is one component of a more extensive pattern of injury known as 'groin disruption injury' consisting of osteitis pubis, conjoint tendinopathy, adductor tendinopathy and obturator nerve entrapment. RISK FACTORS Certain risk factors have been identified, including reduced hip range of motion and poor muscle balance around the pelvis, limb length discrepancy and pelvic instability. The suggested aetiology of the injury is repetitive athletic loading of the symphysis pubis disc, leading to accelerated disc degeneration with consequent pelvic instability and vulnerability to micro-fracturing along the pubic osteochondral junction, periosteal stripping of the pubic ligaments and para-symphyseal tendon tears, causing tendon dysfunction. RADIOLOGY: Diagnostic imaging includes an erect pelvic radiograph (X-ray) with flamingo stress views of the symphysis pubis, real-time ultrasound and, occasionally, computed tomography (CT) scanning and magnetic resonance imaging (MRI), but seldom contrast herniography. Other imaging tests occasionally performed can include nuclear bone scan, limb leg measurement and test injections of local anaesthetic/corticosteroid. PREVENTION AND TREATMENT: The injury may be prevented by the detection and monitoring of players at risk and by correcting significant limb length inequality. Groin reconstruction operation consists of a Maloney darn hernia repair technique, repair of the conjoint tendon, transverse adductor tenotomy and obturator nerve release. Rehabilitation involves core stabilisation exercises and the maintenance of muscle control and strength around the pelvis. OUTCOME Using this regimen of groin reconstruction and post-operative rehabilitation, a player would be anticipated to return to their pre-injury level of activity approximately 3 months after surgery.
Collapse
|
36
|
Morales-Conde S, Socas M, Barranco A. Sportsmen hernia: what do we know? Hernia 2010; 14:5-15. [PMID: 20058044 DOI: 10.1007/s10029-009-0613-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Accepted: 12/13/2009] [Indexed: 11/28/2022]
Abstract
Athletes and other physically active people often suffer prolonged inguinal pain, which can become a serious debilitating condition and may place an athlete's career at risk. A sportsmen hernia is a controversial cause of this chronic groin pain, as it is difficult to be defined. From an anatomical point of view, the definition and the name of this entity should be reviewed. In the majority of athletic manoeuvres, a tremendous amount of torque or twisting occurs in the mid-portion of the body and the front, or anterior portion, of the pelvis accounts for the majority of the force. The main muscles inserting at or near the pubis are the rectus abdominis muscle, which combines with the transversus abdominis. Across from these muscles, and directly opposing their forces, is the abductor longus. These opposing forces cause a disruption of the muscle/tendon at their insertion site on the pubis, so the problem could be related to the fact that the forces are excessive and imbalanced, and a weak area at the groin could be increased due to the forces produced by the muscles. The forces produced by these muscles may be imbalanced and could produce a disruption of the muscle/tendon at their insertion site on the pubis or/and a weak area may be increased due to the forces produced by the muscles, and just this last possibility could be defined as "sportsmen hernia." In conclusion, this global entity could be considered to be an imbalance of the muscles (abductor and abdominal) at the pubis, that leads to an increase of the weakness of the posterior wall of the groin and produces a tendon enthesitis, once a true origin is not detected, that may lead to a degenerative arthropathy of the pubic symphysis in the advanced stages. Based on this, this entity could be re-named as "syndrome of muscle imbalance of the groin" and the sportsmen hernia could be considered as an entity included in this syndrome. It is recommended that a multidisciplinary approach is given to this entity, since the present literature does not supply the proper diagnostic studies and the correct treatment which should be performed in these patients.
Collapse
|
37
|
Abstract
The aim of this article is to emphasize the importance of MR imaging in the evaluation of chronic hip pain and overuse injuries. Image interpretation of the hip can be difficult because of the complex anatomy and the varied pathology that athletes can present with, such as labral and cartilaginous injuries, surrounding soft tissue derangement involving muscles or tendons, and osseous abnormalities. The differential diagnosis in adults is diverse and includes such common entities as stress fracture, avulsive injuries, snapping-hip syndrome, iliopsoas bursitis, femoroacetabular impingement syndrome, tendinosis, and tears of the gluteal musculature.
Collapse
|
38
|
Pubic inguinal pain syndrome: the so-called sports hernia. Hernia 2010; 14:1-4. [PMID: 20052510 DOI: 10.1007/s10029-009-0610-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Accepted: 12/04/2009] [Indexed: 10/20/2022]
|
39
|
Abstract
Persistent anterior hip pain, in young adults, presents a diagnostic and treatment challenge to hip surgeons. Diagnosis, in some cases, is difficult because available diagnostic tools are not very reliable, resulting in a difficult decision making process. This article discusses the possible causes, current knowledge of the condition and outlines a method to approach this difficult problem.
Collapse
Affiliation(s)
- V D Shetty
- Department of Orthopaedic Surgery, LH Hiranandani Hospital, Powai, Mumbai, India.
| |
Collapse
|
40
|
|
41
|
Omar IM, Zoga AC, Kavanagh EC, Koulouris G, Bergin D, Gopez AG, Morrison WB, Meyers WC. Athletic pubalgia and "sports hernia": optimal MR imaging technique and findings. Radiographics 2008; 28:1415-38. [PMID: 18794316 DOI: 10.1148/rg.285075217] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Groin injuries are common in athletes who participate in sports that require twisting at the waist, sudden and sharp changes in direction, and side-to-side ambulation. Such injuries frequently lead to debilitating pain and lost playing time, and they may be difficult to diagnose. Diagnostic confusion often arises from the complex anatomy and biomechanics of the pubic symphysis region, the large number of potential sources of groin pain, and the similarity of symptoms in athletes with different types or sites of injury. Many athletes with a diagnosis of "sports hernia" or "athletic pubalgia" have a spectrum of related pathologic conditions resulting from musculotendinous injuries and subsequent instability of the pubic symphysis without any finding of inguinal hernia at physical examination. The actual causal mechanisms of athletic pubalgia are poorly understood, and imaging studies have been deemed inadequate or unhelpful for clarification. However, a large-field-of-view magnetic resonance (MR) imaging survey of the pelvis, combined with high-resolution MR imaging of the pubic symphysis, is an excellent means of assessing various causes of athletic pubalgia, providing information about the location of injury, and delineating the severity of disease. Familiarity with the pubic anatomy and with MR imaging findings in athletic pubalgia and in other confounding causes of groin pain allows accurate imaging-based diagnoses and helps in planning treatment that targets specific pathologic conditions.
Collapse
Affiliation(s)
- Imran M Omar
- Department of Radiology, Northwestern Memorial Hospital, 676 N Saint Clair St, Chicago, IL 60611, USA.
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Proposed algorithm for the management of athletes with athletic pubalgia (sports hernia): a case series. J Orthop Sports Phys Ther 2008; 38:768-81. [PMID: 19047766 DOI: 10.2519/jospt.2008.2846] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN A case series of 6 athletes with a suspected sports hernia. BACKGROUND Groin pain in athletes is common, and 1 source of groin pain is athletic pubalgia, or a sports hernia. Description of this condition and its management is scarce in the physical therapy literature. The purpose of this case series is to describe a conservative approach to treating athletes with a likely sports hernia and to provide physical therapists with an algorithm for managing athletes with this dysfunction. CASE DESCRIPTION Six collegiate athletes (age range, 19-22 years; 4 males, 2 females) with a physician diagnosis of groin pain secondary to possible/probable sports hernia were referred to physical therapy. A method of evaluation was constructed and a cluster of 5 key findings indicative of a sports hernia is presented. The athletes were managed according to a proposed algorithm and received physical therapy consisting of soft tissue and joint mobilization/manipulation, neuromuscular re-education, manual stretching, and therapeutic exercise. OUTCOMES Three of the athletes received conservative intervention and were able to fully return to sport after a mean of 7.7 sessions of physical therapy. The other 3 athletes reached this outcome after surgical repair and a mean of 6.7 sessions of physical therapy. DISCUSSION Conservative management including manual therapy appears to be a viable option in the management of athletes with a sports hernia. Follow-up randomized clinical trials should be performed to further investigate the effectiveness of conservative rehabilitation compared to a homogeneous group of patients undergoing surgical repair for this condition. LEVEL OF EVIDENCE Therapy, level 4.
Collapse
|
43
|
Choi H, McCartney M, Best TM. Treatment of osteitis pubis and osteomyelitis of the pubic symphysis in athletes: a systematic review. Br J Sports Med 2008; 45:57-64. [PMID: 18812419 DOI: 10.1136/bjsm.2008.050989] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The authors examined the most current evidence for treatment options in athletes with osteitis pubis and osteomyelitis pubis, attempting to determine which options provide optimal pain relief with rapid return to sport and prevention of symptom reoccurrence. METHODS Three databases-MEDLINE, Cochrane Database of Systematic Reviews and CINAHL-were searched using the OVID interface for all years between 1985 and May 2008. References were analysed from included studies, and additional relevant articles were obtained for inclusion. Inclusion criteria included (1) humans only, (2) subjects had no apparent risk factors for development of osteitis pubis or osteomyelitis of the pubic symphysis other than athletic involvement, (3) both physical exam findings and diagnostic imaging were used to confirm either diagnosis, and (4) a definitive treatment strategy was identifiable for management of osteitis pubis or osteomyelitis of the pubic symphysis. In total, 25 articles were included in the review. RESULTS There were no randomised controlled trials identified with this study's search strategy. A total of 195 athletes were diagnosed as having osteitis pubis (186 males, nine females) and treated with either conservative measures/physical therapy, local injection with corticosteroids and/or local anaesthetic, dextrose prolotherapy, surgery or antibiotic therapy. Six case reports/series described conservative treatment measures (physical therapy, rest, non-steroid anti-inflammatory drugs). Four case series explored the use of corticosteroid injections in treatment. One case series described the use of dextrose prolotherapy as a treatment modality. Six case series described various surgical techniques (pubic symphysis curettage, polypropylene mesh placement and pubic bone stabilisation) in treatment. Ten case reports/series (10 subjects) outlined antibiotic treatment of osteomyelitis of the pubic symphysis. CONCLUSIONS The current medical literature shows only level 4 evidence of the treatment for osteitis pubis in 24 case reports/series in athletes. Without any direct comparison of treatment modalities, it is difficult to determine which individual treatment option is the most efficacious. Further study comparing the different treatment options is necessary to determine which modality provides the fastest return to sport.
Collapse
Affiliation(s)
- Haemi Choi
- The Ohio State University Sports Medicine Center, Columbus, 43221, USA.
| | | | | |
Collapse
|
44
|
Zoga AC, Kavanagh EC, Omar IM, Morrison WB, Koulouris G, Lopez H, Chaabra A, Domesek J, Meyers WC. Athletic Pubalgia and the “Sports Hernia”: MR Imaging Findings. Radiology 2008; 247:797-807. [DOI: 10.1148/radiol.2473070049] [Citation(s) in RCA: 181] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
45
|
Jansen JACG, Mens JMA, Backx FJG, Kolfschoten N, Stam HJ. Treatment of longstanding groin pain in athletes: a systematic review. Scand J Med Sci Sports 2008; 18:263-74. [DOI: 10.1111/j.1600-0838.2008.00790.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
46
|
Kark AE, Kurzer M. Groin hernias in women. Hernia 2008; 12:267-70. [DOI: 10.1007/s10029-007-0330-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Accepted: 12/11/2007] [Indexed: 10/22/2022]
|
47
|
Lepere M, Benchetrit S, Bertrand JC, Chalbet JY, Combier JP, Detruit B, Herbault G, Jarsaillon P, Lagoutte J, Levard H, Rignier P. Laparoscopic resorbable mesh fixation. Assessment of an innovative disposable instrument delivering resorbable fixation devices: I-Clip(TM). Final results of a prospective multicentre clinical trial. Hernia 2007; 12:177-83. [PMID: 18085347 DOI: 10.1007/s10029-007-0317-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Accepted: 11/13/2007] [Indexed: 01/28/2023]
Abstract
BACKGROUND The aim of this study was to assess the performance and tolerance of an innovative disposable instrument delivering resorbable clips (I-Clip, Sofradim, France) intended for mesh fixation in inguinal, incisional and umbilical hernias of the abdominal wall. The fixation device was designed to be resorbable in 1 year, with reduced trauma to the underlying tissues or the mesh, and with initial mechanical properties equivalent to those of conventional metal staples. METHODS The study involved 105 patients with inguinal, umbilical or incisional hernias enrolled from 11 centres. Inguinal totally extra peritoneal (TEP) or trans abdomino pre-peritoneal (TAPP) repair was performed with Parietex mesh, incisional or umbilical hernias were treated via the intraperitoneal route with Parietex composite. I-Clips were used for mesh fixation in both indications according to the surgeon's habits. Efficacy was the principal assessment criteria evaluated by two parameters: quality of fixation evaluated subjectively at the time of procedure and recurrence rate according to the follow up at 1, 6 and 12 months. Pain evaluated by the patients using a visual analogue scale (VAS) was the principal secondary assessment criteria. Other tolerance criteria were also evaluated during surgery and follow up. RESULTS The surgeons' evaluation of the fixation quality was assessed as good to very good in 100% of ventral hernias and good to very good in 85-92% of inguinal hernias. At 1 month, 90% of patients (94/104) were totally pain-free (VAS score: 0) and only ten patients reported low pain (VAS scores: 0.3-3.1). At 1 year, the pain described by those ten patients finally disappeared, 98% of patients (102/104) were totally pain-free. The rate of minor complications not related to the device concerned 5% of the patients at 1 month, which was reduced to 2% at one year and no recurrence or mesh sepsis was observed. CONCLUSIONS The ease of use of this device, combined with the absence of recurrence related to the investigated device and the good pain-free outcome in this group of patients confirmed the effectiveness and tolerance of the resorbable fixation concept of I-Clip(TM).
Collapse
Affiliation(s)
- M Lepere
- Clinique St. Charles, 11 bd René Levesque, BP 669, 85016 La Roche sur Yon Cedex, France.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Bussières AE, Taylor JA, Peterson C. Diagnostic Imaging Practice Guidelines for Musculoskeletal Complaints in Adults—An Evidence-Based Approach. J Manipulative Physiol Ther 2007; 30:684-717. [DOI: 10.1016/j.jmpt.2007.10.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2007] [Revised: 09/12/2007] [Accepted: 10/14/2007] [Indexed: 12/26/2022]
|
49
|
Meyers WC, Yoo E, Devon ON, Jain N, Horner M, Lauencin C, Zoga A. Understanding “Sports Hernia” (Athletic Pubalgia): The Anatomic and Pathophysiologic Basis for Abdominal and Groin Pain in Athletes. OPER TECHN SPORT MED 2007. [DOI: 10.1053/j.otsm.2007.09.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
50
|
Nofsinger CC, Kelly BT. Methodical Approach to the History and Physical Exam of Athletic Groin Pain. OPER TECHN SPORT MED 2007. [DOI: 10.1053/j.otsm.2007.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|