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Fasulo SM, Dávila Castrodad IM, Kraeutler MJ, Doerr N, Talishinskiy T, Scillia AJ. Robotic Abdominal Wall Repair with Endoscopic Adductor Lengthening: A Minimally Invasive Approach for Core Muscle Injuries. Arthrosc Tech 2022; 11:e2233-e2241. [PMID: 36632407 PMCID: PMC9827066 DOI: 10.1016/j.eats.2022.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/16/2022] [Indexed: 11/18/2022] Open
Abstract
Groin pain is a common complaint in sports medicine practices but can be a challenge to accurately diagnose given the expanse of differentials. In the athlete, groin pain may be caused by a core muscle injury, also known as sports hernia or athletic pubalgia. These injuries most frequently occur in young males who participate in explosive and rotationally demanding activities such as soccer, football, and ice hockey, which generate large forces across the trunk and hip joint. These injuries are becoming more frequently diagnosed, in part, due to the utilization of diagnostic modalities, such as dynamic ultrasound and magnetic resonance imaging (MRI) and sensitive physical examination tests, such as the cross-body sit-up and squeeze test. When conservative management fails, surgical intervention is a good option for the athletes who desire to return to play. Surgical options include both open and laparoscopic techniques to repair abdominopelvic defects with or without attention to adductor pathology. The purpose of this article is to present a technique for minimally invasive robotic abdominal wall repair with endoscopic adductor lengthening for core muscle injuries.
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Affiliation(s)
- Sydney M. Fasulo
- Department of Orthopaedic Surgery, St. Joseph’s University Medical Center, Paterson, New Jersey, U.S.A
| | - Iciar M. Dávila Castrodad
- Department of Orthopaedic Surgery, St. Joseph’s University Medical Center, Paterson, New Jersey, U.S.A
| | - Matthew J. Kraeutler
- Department of Orthopaedic Surgery, St. Joseph’s University Medical Center, Paterson, New Jersey, U.S.A
| | - Nikki Doerr
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey, U.S.A
| | - Toghrul Talishinskiy
- Department of Orthopaedic Surgery, St. Joseph’s University Medical Center, Paterson, New Jersey, U.S.A.,Rowan University School of Osteopathic Medicine, Stratford, New Jersey, U.S.A
| | - Anthony J. Scillia
- Department of Orthopaedic Surgery, St. Joseph’s University Medical Center, Paterson, New Jersey, U.S.A.,Seton Hall University, South Orange, New Jersey, U.S.A.,Hackensack Meridian School of Medicine, Nutley, New Jersey, U.S.A.,Address correspondence to Anthony J. Scillia, M.D., St. Joseph’s University Medical Center, Department of Orthopaedic Surgery, 703 Main St., Paterson, NJ 07503, U.S.A.
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Serafim TT, Oliveira ES, Migliorini F, Maffulli N, Okubo R. Return to sport after conservative versus surgical treatment for pubalgia in athletes: a systematic review. J Orthop Surg Res 2022; 17:484. [DOI: 10.1186/s13018-022-03376-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/29/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
To assess the time required to return to sport (RTS) after conservative versus surgical treatment in athletes for pubalgia.
Methods
The PRISMA guidelines were followed. Pubmed, SportDiscus and Web of Science were last accessed on September 2022. All the studies investigating the time to RTS after conservative versus surgical treatment in athletes for pubalgia.
Results
In total, 33 studies were selected for full text assessment, and 10 studies were included in the qualitative analysis. Seven studies reported data on conservative management, two on surgical management and one compared both. A total of 468 subjects were included for analysis. 58.7% (275 of 468) were soccer players, 5.9% (28 of 468) runners, and 3.8% (18 of 468) hockey players. Two studies did not specify the type of sport. The quality of the studies detailing the results of conservative management was higher than surgical procedures.
Conclusion
This review highlights that individuals undergoing surgery for pubalgia may return to sport earlier than those receiving conservative treatment. However, conservative management should be considered before surgical treatment is indicated.
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3
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Bisciotti GN, Auci A, Bona S, Bisciotti A, Bisciotti A, Cassaghi G, DI Marzo F, DI Pietto F, Eirale C, Panascì M, Parra F, Zini R. Long-standing groin pain syndrome in athletic women: a multidisciplinary assessment in keeping with the italian consensus agreement. J Sports Med Phys Fitness 2021; 62:1199-1210. [PMID: 34931789 DOI: 10.23736/s0022-4707.21.13322-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Long-standing groin pain syndrome (LSGPS) is a form of groin pain syndrome in which the cohort of symptoms reported by patients is experienced for a long period, typically for over 12 weeks, and is recalcitrant to any conservative therapy. The aim of this prospective epidemiological study was to describe the clinical causes of LSGPS in 37 female athletic subjects in Italy through the Groin Pain Syndrome Italian Consensus Conference on terminology, clinical evaluation and imaging assessment in groin pain in athletes classification and guidelines. METHODS Thirty-seven female athletes affected by LSGPS were evaluated following the guidelines issued by the Groin Pain Syndrome Italian Consensus Conference on terminology, clinical evaluation and imaging assessment of groin pain in athletes. RESULTS In the considered population, each patient presented only one pathological cause for LSGPS. The most frequent aetiologies were inguinal pathologies (54.05% of the cases), acetabular labrum tear (18.92%) and pelvic floor disorders (8.11%). Adductor tendinopathy represented only 2.70% of cases. CONCLUSIONS Female athletic patients affected by LSGPS show a similar incidence of inguinal and hip pathologies as in male populations. However, these clinical situations do not seem to be associated in women unlike in the male population. This difference is probably due to particular anatomical differences related to gender. For this reason, women affected by LSGPS represent an important subset of patients. Moreover, adductor tendinopathy is probably overrated as an etiopathogenetic source of LSGPS in women.
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Affiliation(s)
- Gian Nicola Bisciotti
- Paris Saint Germain FC, Paris, France - .,Kinemove Rehabilitations Center, Pontremoli, Massa Carrara, Italy -
| | - Alessio Auci
- Azienda USL Toscana Nord-Ovest, Massa Carrara, Italy
| | - Stefano Bona
- Humanitas Resarch Institute, Rozzano, Milan, Italy
| | | | - Andrea Bisciotti
- Kinemove Rehabilitations Center, Pontremoli, Massa Carrara, Italy
| | | | | | | | | | | | - Federica Parra
- Kinemove Rehabilitations Center, Pontremoli, Massa Carrara, Italy
| | - Raul Zini
- Università degli Studi di Ferrara, Ferrara, Italy.,Maria Cecilia Hospital, Cotignola, Ravenna, Italy
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4
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Afonso J, Claudino JG, Fonseca H, Moreira-Gonçalves D, Ferreira V, Almeida JM, Clemente FM, Ramirez-Campillo R. Stretching for Recovery from Groin Pain or Injury in Athletes: A Critical and Systematic Review. J Funct Morphol Kinesiol 2021; 6:jfmk6030073. [PMID: 34564192 PMCID: PMC8482255 DOI: 10.3390/jfmk6030073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 08/24/2021] [Accepted: 08/27/2021] [Indexed: 01/01/2023] Open
Abstract
Stretching is usually used as part of rehabilitation protocols for groin pain or injury, but its specific contribution to and within multimodal recovery protocols is unclear. Our goal was to systematically review the effects of stretching for the recovery from groin pain or injury. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, with eligibility criteria defined according to PICOS: (Participants) athletes with groin pain or injuries; (Interventions) interventions with stretching as the differentiating factor; (Comparators) comparators not applying stretching; (Outcomes) symptom remission or improvement and/or time to return to sport and/or return to play; (Study design) randomized controlled trials. Searches were performed on 26 March 2021, in CINAHL, Cochrane Library, EBSCO, EMBASE, PEDro, PubMed, Scielo, Scopus, SPORTDiscus, and Web of Science, with no limitations regarding language or date, and no filters. Of 117 retrieved results, 65 were duplicates and 49 were excluded at the screening stage. The three articles eligible for full-text analysis failed to comply with one or more inclusion criteria (participants, intervention and/or comparators). We then went beyond the protocol and searched for non-randomized trials and case series, but no intervention was found where stretching was the differentiating factor. We found no trials specifically assessing the effects of stretching on recovery or improvement of groin pain or injury in athletes. Currently, the efficacy of these interventions is unknown, and more research is warranted.
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Affiliation(s)
- José Afonso
- Centre for Research, Education, Innovation, and Intervention in Sport (CIFI2D), Faculty of Sport of the University of Porto (FADEUP), 4200-450 Porto, Portugal; (J.A.); (V.F.); (J.M.A.)
| | - João Gustavo Claudino
- Laboratory of Biomechanics, School of Physical Education and Sport, Universidade de São Paulo, São Paulo 05403-010, Brazil;
- Research and Development Department, LOAD CONTROL, Contagem 32280-440, Brazil
| | - Hélder Fonseca
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport of the University of Porto (FADEUP), 4200-450 Porto, Portugal; (H.F.); (D.M.-G.)
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-091 Porto, Portugal
| | - Daniel Moreira-Gonçalves
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport of the University of Porto (FADEUP), 4200-450 Porto, Portugal; (H.F.); (D.M.-G.)
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-091 Porto, Portugal
| | - Victor Ferreira
- Centre for Research, Education, Innovation, and Intervention in Sport (CIFI2D), Faculty of Sport of the University of Porto (FADEUP), 4200-450 Porto, Portugal; (J.A.); (V.F.); (J.M.A.)
| | - José Marques Almeida
- Centre for Research, Education, Innovation, and Intervention in Sport (CIFI2D), Faculty of Sport of the University of Porto (FADEUP), 4200-450 Porto, Portugal; (J.A.); (V.F.); (J.M.A.)
| | - Filipe Manuel Clemente
- Escola Superior Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial de Nun’Álvares, 4900-347 Viana do Castelo, Portugal
- Instituto de Telecomunicações, Delegação da Covilhã, 1049-001 Lisboa, Portugal
- Correspondence:
| | - Rodrigo Ramirez-Campillo
- Department of Physical Activity Sciences, Universidad de Los Lagos, Santiago 8320000, Chile;
- Centro de Investigación en Fisiología del Ejercicio, Facultad de Ciencias, Universidad Mayor, Santiago 7500000, Chile
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5
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Bisciotti GN, Auci A, Bona S, Bisciotti A, Bisciotti A, Cassaghi G, DI Marzo F, DI Pietto F, Eirale C, Panascì M, Parra F, Zini R. A multidisciplinary assessment of 320 athletes with long-standing groin pain syndrome in keeping with the Italian consensus agreement: the high incidence and the multiple causes of inguinal and hip pathologies and pubic osteopathy. J Sports Med Phys Fitness 2021; 61:960-970. [PMID: 34296841 DOI: 10.23736/s0022-4707.20.11575-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Groin pain syndrome is an important and increasing problem in numerous sports (e.g. soccer, football, ice hockey, handball and rugby). Long-standing groin pain syndrome is a form of groin pain syndrome in which the cohort of symptoms reported by the patient is experienced for a long period, typically for over 12 weeks, and is recalcitrant to any conservative therapy. Long-standing groin pain syndrome is potentially career-ending for elite athletes. METHODS A descriptive epidemiological study was carried out on 320 athletes (290 men and 30 women) affected by long-standing groin pain syndrome, following the Guidelines issued by the Groin Pain Syndrome Italian Consensus Conference on terminology, clinical evaluation and imaging assessment of groin pain in athlete. RESULTS Amongst the clinical tests for inguinal pathologies, only the External Inguinal Ring Exploration proved conclusive (sensitivity: 0.97; specificity: 0.95; positive predictive value: 0.98; negative predictive value: 0.90; likelihood ratio: 19.4). In testing for adductor tendinopathies, only the Isometric Squeeze with flexed knee and distal resistance (sensitivity: 0.86; specificity: 0.45; positive predictive value: 0.48; negative predictive value: 0.85; likelihood ratio: 5.7) and the Palpatory Test at the pubic insertion of the adductor longus (sensitivity: 0.93; specificity: 0.89; positive predictive value: 0.96; negative predictive value: 0.79; likelihood ratio: 8.5) proved, respectively, useful at times and moderately useful. Among the tests for hip pathologies, only the Flexion Abduction External Rotation Test was seen to be conclusive (sensitivity: 0.90; specificity: 0.93; positive predictive value: 0.98; negative predictive value: 0.72; likelihood ratio: 12.9). In the male population on average, long-standing groin syndrome presents either a single cause or multiple causes in respectively 74% and 26% of cases. Furthermore, almost 58% of all cases traced to a single clinical cause can be attributed to inguinal pathologies alone. Long-standing groin syndrome in the female population shows only one pathological cause with inguinal pathologies, and acetabular labrum tear representing the most frequent etiologies. CONCLUSIONS Men and women exhibit different causes for long-standing groin pain syndrome. Several routine tests used in the clinical evaluation of this condition furnish a low likelihood ratio. Consequently, in order to optimize clinical evaluation and minimize patient discomfort, clinical evaluation should be based on tests with a greater likelihood ratio.
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Affiliation(s)
- Gian N Bisciotti
- Paris Saint Germain FC, Paris, France - .,Kinemove Rehabilitations Center, Pontremoli, Massa-Carrara, Italy -
| | - Alessio Auci
- AUSL Toscana Nord-Ovest, Massa, Massa-Carrara, Italy
| | | | | | - Andrea Bisciotti
- Kinemove Rehabilitations Center, Pontremoli, Massa-Carrara, Italy
| | | | | | | | | | | | - Federica Parra
- Kinemove Rehabilitations Center, Pontremoli, Massa-Carrara, Italy
| | - Raul Zini
- University of Ferrara, Ferrara, Italy.,Maria Cecilia Hospital, Cotignola, Ravenna, Italy
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6
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Swensen Buza S, Lawton CD, Lamplot JD, Pinnamaneni S, Rodeo SA, Dines JS, Young WK, Taylor SA, Nawabi DH. The Hip Physical Examination for Telemedicine Encounters. HSS J 2021; 17:75-79. [PMID: 33967646 PMCID: PMC8077988 DOI: 10.1177/1556331620975708] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 10/30/2020] [Indexed: 12/30/2022]
Affiliation(s)
| | - Cort D. Lawton
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Joseph D. Lamplot
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | | | - Scott A. Rodeo
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Joshua S. Dines
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Warren K. Young
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Samuel A. Taylor
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Danyal H. Nawabi
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
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7
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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
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8
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HIP AND PELVIC STABILITY AND GAIT RETRAINING IN THE MANAGEMENT OF ATHLETIC PUBALGIA AND HIP LABRAL PATHOLOGY IN A FEMALE RUNNER: A CASE REPORT. Int J Sports Phys Ther 2020; 15:1174-1183. [PMID: 33344033 DOI: 10.26603/ijspt20201174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Athletic pubalgia is a prevalent injury in athletes who kick, pivot, and cut, however it is poorly described in the literature. Many athletes with this diagnosis fail conservative management secondary to continued pain with activity and require surgical intervention for return to sport. Purpose The purpose of this case report is to describe an intervention strategy focusing on gait retraining and hip and lumbopelvic stability for a female runner diagnosed with athletic pubalgia and a labral tear of the hip. Case Description This case report involved a 45-year-old female runner who was seen for 14 visits, from examination to return to sport, with a follow up at 12 months post discharge. Interventions included hip, pelvic, and lumbar stability exercises, and gait retraining. Outcomes measurements included: pain on the numeric pain rating scale, the Lower Extremity Functional Scale (LEFS), gait mechanics, strength, and participation in sport. Outcomes At discharge the subject demonstrated improved strength of all muscle groups and changes in lower extremity running biomechanics. Changes in running mechanics included increased cadence, decreased pelvic drop, diminished over striding, and improved knee control with less valgus movement during the stance phase of gait. The subject reported no pain with running or recreational activities at discharge and follow up at 12 months post discharge. Discussion/Conclusion Most of the literature on conservative rehabilitation for athletic pubalgia focuses on athletes whose sports require pivoting and kicking. The literature provides little information on gait analysis and retraining for runners with a diagnosis of athletic pubalgia and/or hip labrum tears. The program used in this case report including gait retraining and hip, pelvic, and lumbar stability training allowed for full return to running in a 45-year-old female with a diagnosis of hip labrum tear and athletic pubalgia. Further research is needed to discern best conservative treatment for runners with athletic pubalgia and/or hip labral tears. Level of evidence 4.
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9
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Koutserimpas C, Vlasis K, Makris MC, Ioannidis A, Konstantinidis MK, Antonakopoulos F, Athanasopoulos P, Mazarakis A, Papagelopoulos PJ, Konstantinidis KM. Operative treatment of athletic pubalgia in competitive athletes: a retrospective study. J Sports Med Phys Fitness 2020; 60:758-763. [PMID: 32438790 DOI: 10.23736/s0022-4707.20.10389-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Athletic pubalgia is an obscure sport injury, presenting mainly with groin pain during twisting movements. The present 15 year study reports outcomes, intraoperative findings and complications of the endoscopic surgical treatment in competitive athletes. METHODS All competitive athletes, from 2004 to 2018, suffering from athletic pubalgia, treated with laparoscopic Total Extra-Peritoneal technique, at the Department of General, Laparoscopic, Oncologic and Robotic Surgery of the Athens Medical Center were included in this retrospective cohort. Postoperative pain, complications, return to previous training routine and patients' satisfaction were evaluated. RESULTS A total of 130 patients (115; 88.5% males and 15; 11.5% females) with a mean age of 26.7±7.5 years were evaluated. Preoperatively, mean numeric scale pain was found to be 7.7±1.7. Three days postoperatively, the mean numeric pain scale was 3.4±1.5, showing 55.8% decrease. The mean time for return to sports activity was found to be 6.27±3.02 weeks. Regarding complications, six patients (4.6%) had slight numbness at the groin area during the first 6 postoperative months and one patient (0.8%) suffered from a postoperative hematoma. No recurrence was observed. At the final follow-up (mean 76.58±46.5 months), a total of 97 (74.7%) patients were very satisfied, 31 (23.8%) satisfied and two (1.5%) not satisfied with the outcome. CONCLUSIONS Laparoscopic operative treatment in competitive athletes suffering from athletic pubalgia seems to offer rapid recovery, rapid return to sports, as well as very low complications rate and no recurrence.
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Affiliation(s)
- Christos Koutserimpas
- Department of Orthopedics and Traumatology - .,Hellenic Air Force General Hospital, Athens, Greece -
| | | | - Marinos C Makris
- Department of Anatomy, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Argyrios Ioannidis
- Department of Anatomy, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael K Konstantinidis
- Department of Anatomy, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Fotios Antonakopoulos
- Department of Anatomy, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Athanasopoulos
- Department of Anatomy, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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10
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Pampaloni E, Pera E, Maggi D, Lucchinelli R, Chiappino D, Costa A, Venturini V, Tarantino G. Association of cetylated fatty acid treatment with physical therapy improves athletic pubalgia symptoms in professional roller hockey players. Heliyon 2020; 6:e04526. [PMID: 32760831 PMCID: PMC7393424 DOI: 10.1016/j.heliyon.2020.e04526] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/01/2020] [Accepted: 07/17/2020] [Indexed: 11/26/2022] Open
Abstract
Background Athletic pubalgia (AP), a frequent problem among professional roller hockey players (PRHPs), consists of lower abdominal and groin pain, without the presence of true hernia. Aims We assessed cetylated fatty acids (CFAs) in association with conservative therapy for treatment of AP in PRHPs. Methods Ultrasound examination was performed before and after treatment. Strength tests were performed and AP-related pain was measured during the treatment period. Findings Nine of 10 enrolled PRHPs completed a 12-week treatment with CFAs in association with conservative therapy, consisting of manual therapy, diathermy or ultrasonography. Initial ultrasound examination showed AP signs in 7 (70%) of 10 PRHPs. After 12 weeks of therapy, these signs could only be detected by ultrasound in 2 (22.2%) of 9 PRHPs. An increase in muscle strength (already after first week of treatment) and a reduction of AP-related pain were also observed during the treatment. Conclusion The association of CFA treatment with a conservative rehabilitation therapy improves muscle strength and pain and may accelerate recovery from AP.
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11
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Todeschini K, Daruge P, Bordalo-Rodrigues M, Pedrinelli A, Busetto AM. >Imaging Assessment of the Pubis in Soccer Players. Rev Bras Ortop 2019; 54:118-127. [PMID: 31363256 PMCID: PMC6529323 DOI: 10.1016/j.rbo.2017.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 12/21/2017] [Indexed: 11/25/2022] Open
Abstract
Objective
To compare the accuracy of ultrasound (US) with that of magnetic resonance imaging (MRI) in the detection of aponeurosis lesions of the rectus abdominis/adductor longus muscles, to study the characteristics of the athletes and imaging findings associated with pubalgia, and to demonstrate the importance of each method in evaluating this condition.
Materials and methods
The present study was conducted from 2011 to 2016 with 39 professional soccer players: 15 with pubalgia and 24 without pubalgia. Age, field position, body mass index (BMI), weekly training load, career length, and history of thigh/knee injury and lower back pain were recorded. The following tests were performed: radiographs (anteroposterior view of the pelvis in standing and flamingo positions) to evaluate hip impingement, sacroiliac joint, and pubic symphysis instability; US to analyze the common aponeurosis of the rectus abdominis/adductor longus muscles and inguinal hernias; and MRI for pubic bone degenerative alterations and edema, and lesions in the adductor and rectus abdominis muscles and their aponeurosis.
Results
There was an association between pubalgia, high BMI (
p
= 0.032) and muscle alterations (
p
< 0.001). Two patients with pubalgia had inguinal hernias and one patient with pubalgia and two controls had sports hernias. Pubic degenerative changes were frequent in both groups. Aponeurosis lesions were more frequent in patients with pain. The US detection had 44.4% sensitivity and 100% specificity.
Conclusion
The evaluation of athletic pubalgia should be performed with radiography, US, and MRI. High BMI, muscle injuries, geodes, and osteophytes are findings associated with pubalgia; US has low sensitivity to detect injuries of the common aponeurosis of the rectus abdominis/adductor longus muscles.
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Affiliation(s)
- Karina Todeschini
- Hospital Santa Monica, Erechim, RS, Brasil
- Address for correspondence Karina Todeschini Hospital Santa MonicaErechim, RSBrasil
| | - Paulo Daruge
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Marcelo Bordalo-Rodrigues
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - André Pedrinelli
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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12
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Abouelnaga WA, Aboelnour NH. Effectiveness of Active Rehabilitation Program on Sports Hernia: Randomized Control Trial. Ann Rehabil Med 2019; 43:305-313. [PMID: 31311252 PMCID: PMC6637051 DOI: 10.5535/arm.2019.43.3.305] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 12/27/2018] [Indexed: 01/26/2023] Open
Abstract
Objective To determine whether an active rehabilitation program that involves repetitive effortful muscle contractions, including core stability, balancing exercises, progressive resistance exercises, and running activities, after a sports hernia, is effective. Methods Forty soccer players with sports hernias were randomly divided into two equal groups: group A (active rehabilitation program) and group B (conventional treatment). The methods of assessment included a visual analog scale (VAS) and hip internal and external range of motion assessments. Group A received conventional treatment (heat, massage, transcutaneous electrical nerve stimulation, and mobilization) plus an active rehabilitation program, while group B received only conventional treatment. Three treatment sessions were given each week for 2 months. Evaluations were performed pre- and post-treatment. Results A decrease in VAS was seen in both groups at the end of treatment, 80.25% in group A and 41.93% in group B. The difference between the two groups was statistically significant (p=0.0001), whereas there were no statistical differences in internal and external rotation between the groups at the end of treatment (p>0.05). After treatment, an improvement in outcome measures of group A compared to group B (p=0.01) was seen. Thirteen patients in group A and only three patients in group B returned to sports activities without groin pain. Conclusion Active rehabilitation was effective for sports hernia management measured by a decrease in pain and the return to sports.
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Affiliation(s)
- Walid Ahmed Abouelnaga
- Physical Therapy Department for Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Nancy Hassan Aboelnour
- Physical Therapy Department for Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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13
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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.
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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
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Feldman K, Franck C, Schauerte C. Management of a nonathlete with a traumatic groin strain and osteitis pubis using manual therapy and therapeutic exercise: A case report. Physiother Theory Pract 2018; 36:753-760. [PMID: 29979902 DOI: 10.1080/09593985.2018.1492658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Without a definitive single pathoanatomical origin for groin pain, management is difficult. The purpose of this case report is to describe the differential diagnosis and management of an individual with a traumatic groin strain. Case Description: A 47-year-old sedentary male truck driver presented to physical therapy with a 2-month history of right medial groin pain. Pushing the gas pedal and sitting were painful activities. Pain was 3-8/10 on the Numeric Pain Rating Scale (NPRS). The patient reported 46/80 on the Lower Extremity Functional Scale. Examination: Tenderness was noted along the adductor longus muscle belly, right pubic ramus and hip range of motion was limited. Special tests directed at the hip and pelvic region indicated intraarticular and pelvic dysfunction. Treatment included hip and pubic symphysis joint mobilizations, lumbopelvic manipulation, adductor longus soft-tissue mobilization, and core strengthening. Outcome: 12 sessions of physical therapy resulted in LEFS to 80/80, Global Rating of Change (GROC) + 7, and NPRS 0/10 at worst. The patient returned to full work without restriction. Discussion: Groin pain has many pathoanatomical drivers. Management of a traumatic groin injury requires a thorough evaluation and a global treatment approach, in order to improve outcomes and reduce the risk of the pathology becoming chronic.
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Affiliation(s)
- Kyle Feldman
- Physical Therapy Specialists of Winchester , Winchester, VA, USA
| | - Carla Franck
- Kepros Physical Therapy and Performance , Cedar Rapids, IA, USA
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15
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Athletes with inguinal disruption benefit from endoscopic totally extraperitoneal (TEP) repair. Hernia 2018; 22:517-524. [DOI: 10.1007/s10029-018-1741-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 01/19/2018] [Indexed: 10/18/2022]
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16
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Bisciotti GN, Volpi P, Zini R, Auci A, Aprato A, Belli A, Bellistri G, Benelli P, Bona S, Bonaiuti D, Carimati G, Canata GL, Cassaghi G, Cerulli S, Delle Rose G, Di Benedetto P, Di Marzo F, Di Pietto F, Felicioni L, Ferrario L, Foglia A, Galli M, Gervasi E, Gia L, Giammattei C, Guglielmi A, Marioni A, Moretti B, Niccolai R, Orgiani N, Pantalone A, Parra F, Quaglia A, Respizzi F, Ricciotti L, Pereira Ruiz MT, Russo A, Sebastiani E, Tancredi G, Tosi F, Vuckovic Z. Groin Pain Syndrome Italian Consensus Conference on terminology, clinical evaluation and imaging assessment in groin pain in athlete. BMJ Open Sport Exerc Med 2016; 2:e000142. [PMID: 28890800 PMCID: PMC5566259 DOI: 10.1136/bmjsem-2016-000142] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 12/14/2022] Open
Abstract
The nomenclature and the lack of consensus of clinical evaluation and imaging assessment in groin pain generate significant confusion in this field. The Groin Pain Syndrome Italian Consensus Conference has been organised in order to prepare a consensus document regarding taxonomy, clinical evaluation and imaging assessment for groin pain. A 1-day Consensus Conference was organised on 5 February 2016, in Milan (Italy). 41 Italian experts with different backgrounds participated in the discussion. A consensus document previously drafted was discussed, eventually modified, and finally approved by all members of the Consensus Conference. Unanimous consensus was reached concerning: (1) taxonomy (2) clinical evaluation and (3) imaging assessment. The synthesis of these 3 points is included in this paper. The Groin Pain Syndrome Italian Consensus Conference reached a consensus on three main points concerning the groin pain syndrome assessment, in an attempt to clarify this challenging medical problem.
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Affiliation(s)
- G N Bisciotti
- Qatar Orthopedic and Sport Medicine Hospital, Doha, Qatar
| | - P Volpi
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy.,FC Internazionale, Milan, Italy
| | - R Zini
- Azienda Ospedaliera "Ospedale San Salvatore", Pesaro, Italy
| | - A Auci
- Kinemove Rehabilitation Center, Pontremoli, La Spezia, Italy
| | | | - A Belli
- FC Internazionale, Milan, Italy
| | | | | | - S Bona
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | - D Bonaiuti
- Fisioclinic Centro Medico Polispecialistico, Pesaro, Italy
| | - G Carimati
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | | | - G Cassaghi
- Kinemove Rehabilitation Center, Pontremoli, La Spezia, Italy
| | - S Cerulli
- Institute of Sports Medicine of Turin, Italy
| | - G Delle Rose
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | | | - F Di Marzo
- Azienda Ospedaliera Universitaria di Udine, Italy
| | | | - L Felicioni
- Ospedale della Misericordia, Grosseto, Italy
| | | | - A Foglia
- Studio di fisioterapia Riabilita, Pesaro, Italy
| | - M Galli
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | | | - L Gia
- Azienda Ospedaliera Universitaria di Udine, Italy
| | | | - A Guglielmi
- Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - A Marioni
- Azienda Policlinico Università di Bari, Bari, Italy
| | | | | | - N Orgiani
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | | | - F Parra
- Kinemove Rehabilitation Center, Pontremoli, La Spezia, Italy
| | - A Quaglia
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | - F Respizzi
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | - L Ricciotti
- Kinemove Rehabilitation Center, Pontremoli, La Spezia, Italy
| | | | | | | | | | - F Tosi
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | - Z Vuckovic
- Qatar Orthopedic and Sport Medicine Hospital, Doha, Qatar
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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]
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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.
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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
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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.
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Hammoud S, Bedi A, Voos JE, Mauro CS, Kelly BT. The recognition and evaluation of patterns of compensatory injury in patients with mechanical hip pain. Sports Health 2014; 6:108-18. [PMID: 24587859 PMCID: PMC3931342 DOI: 10.1177/1941738114522201] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Context: In active individuals with femoroacetabular impingement (FAI), the resultant reduction in functional range of motion leads to high impaction loads at terminal ranges. These increased forces result in compensatory effects on bony and soft tissue structures within the hip joint and hemipelvis. An algorithm is useful in evaluating athletes with pre-arthritic, mechanical hip pain and associated compensatory disorders. Evidence Acquisition: A literature search was performed by a review of PubMed articles published from 1976 to 2013. Level of Evidence: Level 4. Results: Increased stresses across the bony hemipelvis result when athletes with FAI attempt to achieve supraphysiologic, terminal ranges of motion (ROM) through the hip joint required for athletic competition. This can manifest as pain within the pubic joint (osteitis pubis), sacroiliac joint, and lumbosacral spine. Subclinical posterior hip instability may result when attempts to increase hip flexion and internal rotation are not compensated for by increased motion through the hemipelvis. Prominence of the anterior inferior iliac spine (AIIS) at the level of the acetabular rim can result in impingement of the anterior hip joint capsule or iliocapsularis muscle origin against the femoral head-neck junction, resulting in a distinct form of mechanical hip impingement (AIIS subspine impingement). Iliopsoas impingement (IPI) has also been described as an etiology for anterior hip pain. IPI results in a typical 3-o’clock labral tear as well as an inflamed capsule in close proximity to the overlying iliopsoas tendon. Injury in athletic pubalgia occurs during high-energy twisting activities in which abnormal hip ROM and resultant pelvic motion lead to shearing across the pubic symphysis. Conclusion: Failure to recognize and address concomitant compensatory injury patterns associated with intra-articular hip pathology can result in significant disability and persistent symptoms in athletes with pre-arthritic, mechanical hip pain. Strength-of-Recommendation Taxonomy (SORT): B
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Affiliation(s)
- Sommer Hammoud
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Asheesh Bedi
- MedSport, Division of Sports Medicine and Shoulder Surgery, University of Michigan, Ann Arbor, Michigan
| | - James E Voos
- Orthopaedic and Sports Medicine Clinic of Kansas City, Kansas City, Missouri
| | - Craig S Mauro
- Select Specialty Hospital-Pittsburgh, Pittsburgh, Pennsylvania
| | - Bryan T Kelly
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Mohammad WS, Abdelraouf OR, Elhafez SM, Abdel-Aziem AA, Nassif NS. Isokinetic imbalance of hip muscles in soccer players with osteitis pubis. J Sports Sci 2014; 32:934-9. [PMID: 24499182 DOI: 10.1080/02640414.2013.868918] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In this study, we compared the isokinetic torques of hip flexors/extensors and abductors/adductors in soccer players suffering from osteitis pubis (OP), with normal soccer players. Twenty soccer male athletes with OP and 20 normal soccer athletes were included in this study. Peak torque/body weight (PT/BW) was recorded from hip flexor/extensor and abductor/adductor muscles during isokinetic concentric contraction modes at angular velocity of 2.1 rad · s(-1), for both groups. The results showed a significant difference between the normal and OP groups for hip flexors (P < 0.05). The normal group had significant, lower PT/BW value than the OP group for their hip flexors (P < 0.05). The hip flexor/extensor PT ratio of OP affected and non-affected limbs was significantly different from that of normal dominant and non-dominant limbs. There were no significant differences between the normal and OP groups for hip extensor, adductor and abductor muscles (P > 0.05). Regarding the hip adductor/abductor PT ratio, there was no significant difference between the normal and OP groups of athletes (P > 0.05). The OP group displayed increase in hip flexor strength that disturbed the hip flexor/extensor torque ratio of OP. Therefore, increasing the hip extensor strength should be part of rehabilitation programmes of patients with OP.
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Affiliation(s)
- Walaa Sayed Mohammad
- a Department of Biomechanics, Faculty of Physical Therapy , Cairo University , Giza , Egypt
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22
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Christensen C, Landsettle A, Antoszewski S, Ballard BB, Carey H, Pax Lowes L. Conservative management of congenital muscular torticollis: an evidence-based algorithm and preliminary treatment parameter recommendations. Phys Occup Ther Pediatr 2013; 33:453-66. [PMID: 23387981 DOI: 10.3109/01942638.2013.764959] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To present an algorithm with accompanying treatment parameters for the management of congenital muscular torticollis (CMT) based on the best available literature. METHODS A systematic search of PubMed, MEDLINE, CINHAL, and Cochrane databases was conducted to identify evidence to guide the conservative management of CMT. RESULTS An evidence-based algorithm was created based on three prognostic factors that influence treatment duration and outcome, including a sternocleidomastoid fibrotic mass, passive range of motion rotation deficit, and age at initiation of treatment. Preliminary treatment parameter recommendations for clinic and home programming accompany the algorithm. CONCLUSION Use of the proposed evidence-based algorithm with accompanying preliminary treatment parameter recommendations may improve consistency of care and outcomes for infants with CMT. While a higher level of evidence supports the three prognostic factors utilized in the algorithm, research gaps continue to exist with regards to treatment parameters.
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Affiliation(s)
- Catie Christensen
- The Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH, USA
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23
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Mei-Dan O, Lopez V, Carmont MR, McConkey MO, Steinbacher G, Alvarez PD, Cugat RB. Adductor tenotomy as a treatment for groin pain in professional soccer players. Orthopedics 2013; 36:e1189-97. [PMID: 24025012 DOI: 10.3928/01477447-20130821-23] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Chronic, exercise-related groin pain is a debilitating condition. Nonoperative treatment has limited efficacy, but surgical intervention on the adductor-abdomino complex may be used to alleviate symptoms and allow return to play (RTP). The purpose of this study was to report the outcome of adductor tenotomy and hernioplasty for professional soccer players with groin pain. Between 2000 and 2006, a total of 155 professional and recreational soccer players with recalcitrant groin pain (with or without lower abdominal pain) and resistance to conservative treatment were included in this retrospective analysis. Ninety-six patients were treated with adductor tenotomy and 59 patients were treated with combined adductor tenotomy and hernioplasty. No difference in pre- or postoperative parameters was detected between groups, apart from abdominal wall muscle defects revealed during ultrasound for patients in the combined group. The RTP time and subjective and objective outcome measures were compared. A combined score was developed to evaluate outcomes that consisted of overall satisfaction (50%), RTP time (15%), and Tegner scores (35%). Mean RTP was 11 weeks (range, 4-36 weeks). Postoperative Tegner score remained 8.2 (same as the preinjury Tegner score). Subjective outcome was rated 4.3 of 5. The combined score indicated 80% of good or excellent results for both groups. Surgical intervention allows RTP at the same level in professional soccer players following failure of nonoperative treatments. Athletes with adductor syndrome and accompanying sportsman's hernia may benefit from adductor tenotomy alone.
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Hegedus EJ, Stern B, Reiman MP, Tarara D, Wright AA. A suggested model for physical examination and conservative treatment of athletic pubalgia. Phys Ther Sport 2013; 14:3-16. [DOI: 10.1016/j.ptsp.2012.04.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 03/12/2012] [Accepted: 04/06/2012] [Indexed: 12/14/2022]
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Abstract
Both arthroscopic and open operative treatment of femoroacetabular impingement (FAI) can reproducibly relieve hip pain with correction of the underlying osseous deformity and treatment of the associated labral pathology, particularly in patients without substantial articular cartilage injury at the time of surgery. Between 75% and 90% of athletes undergoing FAI surgery return to sports at their pre-injury level of function. There is no peer-reviewed evidence to date reporting on the efficacy of nonoperative treatment and return to play with FAI. Successful operative treatment of impingement requires appropriate and complete correction of the mechanical injury that led to the symptomatic labral pathology. Early intervention prior to the onset of irreversible chondral damage is critical to the long-term success of FAI surgery. Complex deformities involving combinations of static and dynamic mechanical factors often coexist, so careful preoperative evaluation of the underlying structural anatomy is critical to successful treatment planning.
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Affiliation(s)
- Asheesh Bedi
- MedSport, University of Michigan Orthopaedics, Ann Arbor, MI 48106, USA.
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26
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Knesek MJ, Skendzel JG, Kelly BT, Bedi A. Approach to the Patient Evaluation Using Static and Dynamic Hip Pathomechanics. OPER TECHN SPORT MED 2012. [DOI: 10.1053/j.otsm.2012.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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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.
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Affiliation(s)
- Erik A Yuill
- Sports Science Resident, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario M2H 3J1, Canada.
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Freire M, Winalski CS, Miniaci A, Sundaram M. Radiologic case study. Avulsion of the right adductor longus from the symphysis pubis. Orthopedics 2012; 35:85, 158-60. [PMID: 22300988 DOI: 10.3928/01477447-20120123-33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Maxime Freire
- Department of Radiology, University of Mississippi Medical Center, Jackson, Mississippi, USA.
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Preskitt JT. Sports hernia: the experience of Baylor University Medical Center at Dallas. Proc (Bayl Univ Med Cent) 2011; 24:89-91. [PMID: 21566750 DOI: 10.1080/08998280.2011.11928689] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Groin injuries in high-performance athletes are common, occurring in 5% to 28% of athletes. Athletic pubalgia syndrome, or so-called sports hernia, is one such injury that can be debilitating and sport ending in some athletes. It is a clinical diagnosis of chronic, painful musculotendinous injury to the medial inguinal floor occurring with athletic activity. Over the past 12 years, we have operated on >100 patients with this injury at Baylor University Medical Center at Dallas. These patients have included professional athletes, collegiate athletes, competitive recreational athletes, and the occasional "weekend warrior." The repair used is an open technique using a lightweight polypropylene mesh. Patient selection is important, as is collaboration with other experienced and engaged sports health care professionals, including team trainers, physical therapists, team physicians, and sports medicine and orthopedic surgeons. Of the athletes who underwent surgery, 98% have returned to competition. After a minimum of 6 weeks for recovery and rehabilitation, they have usually returned to competition within 3 months.
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Affiliation(s)
- John T Preskitt
- Department of Surgery, Baylor University Medical Center at Dallas
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Zilkens C, Miese F, Jäger M, Bittersohl B, Krauspe R. Magnetic resonance imaging of hip joint cartilage and labrum. Orthop Rev (Pavia) 2011; 3:e9. [PMID: 22053256 PMCID: PMC3206516 DOI: 10.4081/or.2011.e9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 06/10/2011] [Indexed: 11/23/2022] Open
Abstract
Hip joint instability and impingement are the most common biomechanical risk factors that put the hip joint at risk to develop premature osteoarthritis. Several surgical procedures like periacetabular osteotomy for hip dysplasia or hip arthroscopy or safe surgical hip dislocation for femoroacetabular impingement aim at restoring the hip anatomy. However, the success of joint preserving surgical procedures is limited by the amount of pre-existing cartilage damage. Biochemically sensitive MRI techniques like delayed Gadolinium Enhanced MRI of Cartilage (dGEMRIC) might help to monitor the effect of surgical or non-surgical procedures in the effort to halt or even reverse joint damage.
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Affiliation(s)
- Christoph Zilkens
- Department of Orthopaedic Surgery, University Hospital of Düsseldorf, Germany
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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]
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Bedi A, Dolan M, Leunig M, Kelly BT. Static and dynamic mechanical causes of hip pain. Arthroscopy 2011; 27:235-51. [PMID: 21035993 DOI: 10.1016/j.arthro.2010.07.022] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 07/28/2010] [Accepted: 07/28/2010] [Indexed: 02/06/2023]
Abstract
Mechanical hip pain typically has been associated either with dynamic factors resulting in abnormal stress and contact between the femoral head and acetabular rim when the hip is in motion or with static overload stresses related to insufficient congruency between the head and acetabular socket in the axially loaded (standing) position. Compensatory motion may adversely affect the dynamic muscle forces in the pelvic region, leading to further strain and pain. Hip pain related to static overload stresses may also be localized to the anteromedial groin, but compensatory dysfunction of the periarticular musculature may lead to muscular fatigue and associated pain throughout the hip. As our understanding of hip joint mechanics has advanced, it has become increasingly apparent that hip pain in the absence of osteoarthritis may be due to a complex combination of mechanical stresses, both dynamic and static. With an emphasis on findings in the recent literature, this review will describe the dynamic and static factors associated with mechanical hip pain, the combinations of dynamic and static stresses that are commonly identified in hip pain, and common patterns of compensatory injury in patients with femoroacetabular impingement.
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Affiliation(s)
- Asheesh Bedi
- MedSport, University of Michigan, Ann Arbor, Michigan 48106, USA.
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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.
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