Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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36. Sports Hernia with Adductor Tendonitis Fredrick J. Brody and Jeffrey Harr Chief Complaint Pain in the left groin that extends to the thigh. History A 21-year-old lacrosse player presents with an 8- month history of pain in his left groin that radiates to his left upper thigh. The patient first developed these symptoms after an arduous lacrosse practice. He continued to practice in discomfort over the next several days, and was evaluated subsequently by his team doctor who treated him with ice and anti-inflammatories. Despite these treatments, his pain persisted and he was unable to perform explosive lateral movements. Ultimately he underwent two cortisone injections in the groin, which enabled him to complete the season in variable degrees of pain. After the season he avoided all athletic activities for 4 weeks, which resolved his symptoms completely. However, he returned for summer league lacrosse, and his groin and thigh pain returned immediately with strenuous activities. Electronic supplementary material: The online version of this chapter (doi: 10.1007/978-3-319-21587-7_36 ) contains supplementary material, which is available to authorized users. Videos can also be accessed at http://link.springer.com/ chapter/10.1007/978-3-319-21587-7_36 . © Springer International Publishing Switzerland 2016 B.P. Jacob et al. (eds.), The SAGES Manual of Groin Pain, DOI 10.1007/978-3-319-21587-7_36 453
454 F.J. Brody and J. Harr Physical Exam On physical examination , he was exceedingly fit with minimal body fat, pronounced abdominal muscles, and large quadriceps. His abdomen was flat without overt hernia defects. Upon palpation, the left groin was tender, particularly cephalad to the pubic bone at the insertion of the left rectus abdominis . His tenderness extended toward the pubic tubercle and laterally for 2 cm into the inguinal crease. Active sit- ups, with or without resistance, replicated his groin and abdominal pain. He was also tender along the left adductor longus tendon starting at the inferior aspect of the pubic tubercle, and extending along the tendon for 10 cm. The adductor tendon pain was exacerbated with hip adduction and abduction. He had full range of motion of his hip, and there were no clinically evident inguinal hernias even after multiple Valsalva maneuvers. Workup Plain radiographs did not show evidence of femoroacetabular impingement, hip dysplasia, or lumbar or sacroiliac degenerative changes. There was also no evidence of bone resorption or sclerosis. Magnetic resonance imaging (MRI) of the abdomen and pelvis revealed high signal uptake on T1- and T2-weighted images along the pubic bone consistent with pubic osteitis. There was also increased uptake along the left rectus abdominis insertion at the pubic bone consistent with edema and a possible tear. A cleft sign was also visible along the inferior portion of the pubic bone at the insertion of the left adductor longus , signifying a tear of the tendon (Fig. 36.1a, b ). There was no evidence of any associated intra- articular hip pathology. Diagnosis The history, physical exam, and radiologic findings were consistent with the diagnosis of a sports hernia with adductor tendonitis . Other differential diagnoses should include iliopsoas strains or bursitis, avulsion injuries of the pubic bone, nerve entrapment syndromes, stress fractures of the femoral neck or pubic rami, vertebral body pathology, and associated hip injuries [ 1 ]. The most common hip pathology associ-
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Brian P. Jacob · David C. Chen Bru
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The SAGES Manual of Groin Pain Bria
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Foreword Inguinal hernia repair is
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Contents Part I Primary Groin Pain
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Contents ix 22 Management of Inguin
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Contents xi 45 Value-Based Clinical
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xiv Editors and Contributors Jeffre
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xvi Editors and Contributors David
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xviii Editors and Contributors Greg
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xx Editors and Contributors David S
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1. Introduction to Primary and Seco
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10 I.A. Gawlas and W.J. Peacock Ili
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12 I.A. Gawlas and W.J. Peacock Tra
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14 I.A. Gawlas and W.J. Peacock Var
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3. Complex Regional Pain Syndrome T
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4. Chief Complaint of Groin Pain: H
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4. Chief Complaint of Groin Pain…
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42 C. Ma and A. Ramaswamy inguinal
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44 C. Ma and A. Ramaswamy Categoriz
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46 C. Ma and A. Ramaswamy with no s
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48 C. Ma and A. Ramaswamy 26. Aasva
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50 I.M. Daoud and K. Dunn Other per
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52 I.M. Daoud and K. Dunn low herni
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54 I.M. Daoud and K. Dunn In the po
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56 I.M. Daoud and K. Dunn with a he
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58 I.M. Daoud and K. Dunn 13. O’C
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60 G.J. Mancini Occult Hernia Backg
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62 G.J. Mancini Magnetic resonance
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64 G.J. Mancini rocking motion can
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66 G.J. Mancini Unique to the adduc
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68 G.J. Mancini two nerve injuries
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70 G.J. Mancini abdominis has a rep
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72 G.J. Mancini 5. Light D, Ratnasi
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74 J.C. Campbell and G.D. Paiement
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9. Groin Pain Etiology: Spine and B
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10. Groin Pain Etiology: Spermatic
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Table 10.2. European Association of
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138 M. Hibner and C. Coyne Piriform
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140 M. Hibner and C. Coyne Fig. 11.
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142 M. Hibner and C. Coyne Table 11
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144 M. Hibner and C. Coyne present
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146 M. Hibner and C. Coyne Table 11
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148 M. Hibner and C. Coyne Once the
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150 M. Hibner and C. Coyne 3. Hibne
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12. Chronic Pelvic Pain in Women M.
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12. Chronic Pelvic Pain in Women 15
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174 J.M. Miller et al. Knowing the
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176 J.M. Miller et al. Fig. 13.2. A
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182 J.M. Miller et al. Fig. 13.9. C
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184 J.M. Miller et al. Fig. 13.14.
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192 J.M. Miller et al. Cardiac Cath
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194 B.J. Dunkin Noxious peripheral
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196 B.J. Dunkin Table 14.1. Summary
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198 B.J. Dunkin Rectus abdominis Ex
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200 B.J. Dunkin COX-1 COX-2 Celecpx
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202 B.J. Dunkin Table 14.2. Common
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204 B.J. Dunkin Possible Preoperati
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206 B.J. Dunkin Postoperative Pain
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208 B.J. Dunkin Summary Understandi
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15. Chronic Groin Pain Following An
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222 E.L. Felix not seem to alter th
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224 E.L. Felix nerves from the surg
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226 E.L. Felix Fig. 16.2. Lateral f
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228 E.L. Felix It has been establis
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230 E.L. Felix 18. Pollak R, Nyhus
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17. The Orthopedic Perspective on G
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246 J.F.M. Lange Jr. examination an
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248 J.F.M. Lange Jr. and remedial s
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250 J.F.M. Lange Jr. Best available
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252 J.F.M. Lange Jr. Neuropathic pa
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254 J.F.M. Lange Jr. This algorithm
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19. Radiologic Evaluation for Posto
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19 Radiologic Evaluation for Postop
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268 A. Malhotra extended variant of
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270 A. Malhotra steroid injections,
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272 A. Malhotra located just below
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274 A. Malhotra Nociceptive Acute N
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276 A. Malhotra 20. Rozen D, Parvez
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278 R. Álvarez intentionally or in
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Fig. 21.1. Material: A ballpoint pe
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Fig. 21.5. Dermatome mapping compat
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Fig. 21.9. Dermatome mapping compat
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286 R. Álvarez Subsequently, we mu
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288 R. Álvarez G : Granuloma H : H
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290 R. Álvarez Fig. 21.14. Same pa
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292 R. Álvarez 6. Lermite E, Arnau
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294 K.A. Seymour and J.S. Yoo Table
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296 K.A. Seymour and J.S. Yoo repro
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298 K.A. Seymour and J.S. Yoo Recur
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23. Mesh Removal for Chronic Pain:
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23. Mesh Removal for Chronic Pain
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320 I.T. MacQueen et al. inguinodyn
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322 I.T. MacQueen et al. Fig. 24.2.
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324 I.T. MacQueen et al. Timing and
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326 I.T. MacQueen et al. Fig. 24.4.
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328 I.T. MacQueen et al. Posthernio
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330 I.T. MacQueen et al. never be e
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25. Laparoscopic Triple Neurectomy
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26. Chronic Orchialgia: Workup and
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27. The Role of Bioactive Prostheti
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376 G. Campanelli et al. affecting
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378 G. Campanelli et al. into the w
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380 G. Campanelli et al. chronic gr
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382 G. Campanelli et al. A prospect
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384 G. Campanelli et al. open mesh
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386 G. Campanelli et al. 38. Alfier
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29. Prevention of Pain: Optimizing
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30. Prophylactic Neurectomy Versus
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Page 490 and 491: 43. Thoracolumbar Syndrome James A.
Page 492 and 493: 43. Thoracolumbar Syndrome 497 The
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45. Value-Based Clinical Quality Im
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46. Patient Care Manager Perspectiv
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47. Workers’ Compensation: An Occ
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532 Index Athletic pubalgia (cont.)
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534 Index Chronic post-herniorrhaph
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536 Index Groin pain (cont.) magnet
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538 Index Ilioinguinal nerve (IIN)
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540 Index Local anesthetics (cont.)
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542 Index Peripheral nerve entrapme
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544 Index S Sacroiliac (SI) joint d
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546 Index Transperineal pudendal ne
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Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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