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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44. Patient with Referred Hip Pain 503 Treatment The patient was referred to an orthopedic specialist for evaluation and treatment. MR arthrogram confirmed the diagnosis. He underwent joint injection, with resolution of his pain. He is scheduled for arthroscopic surgery. Outcomes and Discussion Hip disorders, especially labral tears, may present with groin pain. A detailed history and physical examination are key to help differentiate their diagnosis from other diagnoses, such as inguinal hernia. In fact, it is not uncommon for a patient to have an inguinal hernia at the same setting of a hip disorder. It is important to correctly diagnose the cause of the patient’s groin pain and to provide treatment focused on that disorder. In my practice, I often see patients who undergo elective inguinal hernia repair, with no improvement in their preoperative symptoms. Workup proves that their preoperative symptoms were indeed due to another pathology, such as a hip disorder, and their inguinal hernia was asymptomatic. A poor outcome would be to have a complication from the elective inguinal hernia repair while at the same time the patient’s main cause of preoperative pain was due to the hip disorder, thus altogether complicating the patient’s plan of care, outcome, and recovery. Key elements in the history can help differentiate hip disorders from groin pain. With hip disorders, the pain is often not relieved with lying flat; there may be a limp or difficulty of weight bearing on the ipsilateral leg. Many patients with hip disorders describe pain as wrapping around the ASIS, like the letter “C,” cupping their thumb and fingers at their waist. The pain is often deeper than expected and lower than expected for an inguinal hernia. Also, a sensation of tearing or pulling is often described, as opposed to a dull or sharp pain. Activities that are remarkably painful include an adduction, such as stepping into or out of a car or sitting cross- legged on the floor. Many patients report a hip click or popping sensation. On physical exam, passive flexion and adduction, with internal rotation, elicit pain and limitation in movement.
504 S. Towfigh Conclusion Hip disorders such as labral tear, may present with groin pain. Their distribution of pain can be similar to that of an inguinal hernia, with groin pain radiating down the leg and around the back and worsening with activities. Key questions in the history can help differentiate a hip disorder from that of an inguinal hernia. Remember that patients with inguinal hernias may have a primary hip problem. A hip X-ray and MRI, preferably a dedicated hip MR arthrogram, are diagnostic. See Chap. 8 , for a full review and discussion on this very important topic.
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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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Table 31.1. Selective neurectomy wi
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408 W.M.J. Reinpold and A.D. Schroe
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32. Chronic Groin Pain: Mesh or No
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Part IV Case Reports and Patients
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430 S. Towfigh were irregular and s
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432 S. Towfigh in addressing her sy
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434 S. Towfigh Conclusion We have y
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436 K.W. Kercher Physical Examinati
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438 K.W. Kercher Fig. 34.4. Left ad
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440 K.W. Kercher Fig. 34.5. After d
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442 K.W. Kercher the posterior wall
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444 K.W. Kercher Table 34.2. Surgic
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35. Chronic Post-inguinal Herniorrh
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35 Chronic Post-inguinal Herniorrha
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Page 486 and 487: 42. Patient with Chronic Pelvic Pai
Page 488 and 489: 42. Patient with Chronic Pelvic Pai
Page 490 and 491: 43. Thoracolumbar Syndrome James A.
Page 492 and 493: 43. Thoracolumbar Syndrome 497 The
Page 494 and 495: 43. Thoracolumbar Syndrome 499 Groi
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Page 500 and 501: 45. Value-Based Clinical Quality Im
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Page 526 and 527: 532 Index Athletic pubalgia (cont.)
Page 528 and 529: 534 Index Chronic post-herniorrhaph
Page 530 and 531: 536 Index Groin pain (cont.) magnet
Page 532 and 533: 538 Index Ilioinguinal nerve (IIN)
Page 534 and 535: 540 Index Local anesthetics (cont.)
Page 536 and 537: 542 Index Peripheral nerve entrapme
Page 538 and 539: 544 Index S Sacroiliac (SI) joint d
Page 540: 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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