1 / 20

Chronic groin pain in athletes

Chronic groin pain in athletes. Charl Carstens CLL 705 September 2012. OVERVIEW. Case Presentation Clinical Progress Special Investigations Treatment Introduction Summary Discussion. Case Presentation. 26 year Male rugby player- hooker C/O: Pain left supra inguinal area

mbaade
Download Presentation

Chronic groin pain in athletes

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Chronic groin pain in athletes Charl Carstens CLL 705 September 2012

  2. OVERVIEW • Case Presentation • Clinical Progress • Special Investigations • Treatment • Introduction • Summary • Discussion

  3. Case Presentation • 26 year Male rugby player- hooker • C/O: Pain left supra inguinal area (illiopsoas) Conservative treatment 1/12 Surgeon referral

  4. Clinical Progress • Re-injured- acute pain left groin • X-ray- NAD • Ultrasound- ?Partial tear or tendinopathy adductor brevis

  5. Progress Cont. • Treatment 9/52 Rest/Rehab: Core stabilizers, hip muscle activation and strengthening • Slipped – pain left groin again

  6. Re- Evaluation • Tender Proximal adductors • Adductor squeeze test- Extension & 90° Hip flexion - adductor longus • FABER (+)

  7. Special Investigations • MRI: Partial avulsion enthesis left pectineus and adductor brevis anterior at inferior attachment of symphysis pubis. Oedema medially in both muscles.

  8. Surgical Treatment • 5 months post injury • Surgery: Extensive tendinopathy of Adductor longus – unilateral tenotomy

  9. Summary • Clinical Chronic groin injury • Personal Professional rugby player • Contextual Pressure from club RTP

  10. Introduction Non-specific exercise related groin pain • Osteitis Pubis/Athletic Pubalgia • Adductor tendinopathy(enthesopathy) • Iliopsoas dysfunction • Sportsman’s hernia/sports hernia • Gilmore’s groin

  11. Discussion • 4 Groin Entities A. Adductor- related B. Iliopsoas- related C. Abdominal wall- related D. Pubic bone stress – related (Brukner & Khan 2012)

  12. 4 Groin Entities • Anatomy: - Adductor Longus & Rectus Abdominus directly linked - Indirectly to Transversus Abdominus & Internal Oblique via Rectus Abdominus sheath

  13. Pubic Joint • Anatomy- 2 Pubic symphyseal bones - 3 Muscle Compartments Anterior: Abdom, Quads, Sartorius, Iliopsoas + Pectineus Medial: 3 Adductors, Gracillis + Obturator externus Posterior: Hamstrings +Part Add Magnus (Meyers et al 2012)

  14. Adductor Longus Related • Enthesopathy rather tendinopathy • Conservative treatment- soft tissue treatment, core stability program & strengthening local muscle groups • If all else fails- cut

  15. Treatment Cont. • Partial tenotomy – transferring load from superficial to deep part (Orchard J.W et al 2004) • ?RTP after 4-6 weeks (Brukner & Khan 2012) • Complete Tenotomy

  16. Treatment Cont. • Unilateral Adductor tenotomy return to pre-injury level of sport: • Atkinson et al 2010 - 54% • Akermark et al 1992 – 62% • Robertson et al 2011 – 68% Advocated 10 – 12 weeks rehabilitation

  17. Treatment Cont. • Bilateral Adductor tenotomy return to pre-injury level of sport or higher: • Maffuli et al 2012 – 76% with 16 weeks rehabilitation

  18. References • Brukner P., Khan K., et al, 2012. Brukner & Khan’s Clinical Sports Medicine. 4th ed. Australia: Mcgraw-Hill Australia. 342-389. • Akermark C. and Johansson C. 1992. Tenotomy of the adductor longus tendon in the treatment of chronic groin pain in athletes. Am J Sports Med. 20:640-643. • Atkinson H.D., Johal P., Falworth M.S., et al 2010. Adductor tenotomy: its role in the management of sports related chronic groin pain. Arch Orthop Trauma Surg. 130(8): 965-70. • Hackney R.G. 2012. Groin pain in athletes. Othop & Trauma 26(1): 25-32.

  19. References Cont. • Maffuli N., Loppini M., Longo U.G., et al. 2012. Bilateral Mini-Invasive Adductor Tenotomy for the management of chronic unilateral adductor longus tendinopathy in athletes. Am J Sports Med. 40(8): 1880-86. • Meyers W.C., Yoo E., Devon O.N., et al 2012. Understanding “Sports Hernia”(Athletic Pubalgia): The Anatomic and Pathophysiological Basis for Abdominal and Groin Pain in Athletes. Oper Tech Sports Med. 20: 33-45. • Orchard J.W., Cook J.L. and Halpin N. 2004. Stress-shielding as a cause of insertional tendinopathy: the operative technique of limited adductor tenotomy supports the theory. J Sci Med Sport. 7(4): 424-8. • Robertson I.J., Curran C., McCaffrey N., et al 2011. Adductor tenopathy in the management of groin pain in athletes. Int J Sports Med. 32(1): 45-48.

More Related