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 457 Subcutaneous tissue Conjoint tendon Pubic tubercle Pubis symphysis Internal oblique muscle Retracted external oblique fascia Transversus abdominis muscle Iliopubic tract Spermatic cord Richardson retractor Fig. 36.2. After undermining the conjoined tendon beneath the relaxing the incision, the flap is secured with a running 2-0 Prolene suture to the iliopubic tract. A second 2-0 Prolene is used to imbricate the first suture line. Transversalis fascia Laterally reflected conjoint tendon Conjoint tendon Subcutaneous tissue Iliopubic tract Pubis symphysis Fig. 36.3. Relaxing incision starts at the pubic tubercle and extends along the conjoined tendon to the level of the deep ring. The relaxing incision also extends medially along the conjoined tendon to release the aponeurosis from the pubic symphysis for approximately 2 cm.
458 F.J. Brody and J. Harr layer starts at the pubic tubercle and extends superiorly to the deep ring. A second layer of 2-0 Prolene imbricates the initial layer. At this point, 10 cc of 0.25 % bupivacaine is injected into the pubic tubercle. Mesh is not placed since the intent of the repair is to lateralize the vector force away from the pubic symphysis and tubercle. The adductor tenotomy is performed to release the vector force that extends inferiorly from the pubic bone to the large muscles of the thigh. Conceptually, the tenotomy divides the vertical vector or the common aponeurosis that incorporates the adductor tendon and rectus sheath. This maneuver dissipates the distracting forces from the pubic bone. Technically, a Deaver retractor is inserted through the inguinal wound, and the subcutaneous tissues are retracted in an avascular plane above the fascia of the adductor longus muscle (Fig. 36.4a ). The tendon is easily palpated as a strong band extending from the pubic bone. Starting at the 12 o’clock position and extending medially and inferiorly, the tenotomy is performed 2 cm from the pubic tubercle (Fig. 36.4b ). The tenotomy extends toward the 7 o’clock position and is performed in a superficial manner, utilizing a right angle dissector to avoid injury to the underlying muscle. The tenotomy separates the overlying tendon and fascia from the underlying adductor longus muscle. Hemostasis is typically well controlled with the electrocautery as long as the muscle is not divided. Associated nerve fibers are encountered rarely in this plane along the upper medial aspect of the adductor musculature. Once the tenotomy is completed, hemostasis is verified. From the inferior aspect, the pubic tubercle and the proximally divided tendons of the adductor longus are injected with 10 cc of 0.25 % bupivacaine. After closing the incision in layers, the patient is extubated and taken to recovery room in stable condition (Videos 36.1 , 36.2 and 36.3 ) . Outcome Upon discharge, the patient’s activity was restricted to walking and activities of daily living. After his first postoperative visit (14 days after surgery), he was allowed to increase his activities slowly, which involved cycling, jogging, and swimming. At 4 weeks, he resumed core activities, including sit-ups and running an under 8-min mile. At 6 weeks, he initiated activities involving lateralizing movements, but fullspeed activities were restricted. After approximately 8 weeks, the patient resumed his normal activities, and ultimately returned for his final sea-
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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 486 and 487: 42. Patient with Chronic Pelvic Pai
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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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