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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4. Chief Complaint of Groin Pain… 35 Maneuver Examination procedure Results Possible diagnoses Stinchfield In the supine position, the leg is actively raised to 30° against downward force from the examiner Ely In the prone position, the knee is passively flexed Involuntary compensatory hip flexion Gaenslen In the supine position with both knees flexed, one thigh is extended over the edge of the table FADIR impingement test In the supine position, the hip is flexed, adducted, and internally rotated Ober In the lateral position with the knee flexed to 90°, the hip is brought into maximal extension and the leg is adducted Thomas Both hips are flexed at the same time while one leg is brought back down to the table Pain or weakness Arthritis Synovitis Femoral neck fracture Iliopsoas tendinitis Rectus femoris contracture Pain Spondyloarthritis Arthritis Sciatica Pain Intra-articular hip pathology Unable to adduct past midline Thigh cannot reach the table IT band contractures Adductor dysfunction Hip flexor contracture
36 J.A. Greenberg presence or absence of pain or hypersensitivity along any of the distributions. Pain mapping, described in Chap. 21 , is another exam tool to help isolate specific nerve dermatomes that are involved in the pathology. Radiographic Studies While radiographic studies certainly play a role in the diagnosis and potential management of groin pain, they are not needed for all patients. In patients with symptomatic inguinal hernias that are palpable on physical exam, radiographic studies are unnecessary, as they will add cost to the workup without significantly changing management. However, for the patient with symptoms suggestive of an inguinal hernia and a normal physical examination, imaging studies may be extremely beneficial. Ultrasonography, magnetic resonance imaging (MRI), computed tomography (CT), and herniography under real-time fluoroscopy can all be used to aid in the diagnosis of occult inguinal hernias. In a systematic review and meta-analysis of imaging techniques in the diagnosis of occult inguinal hernias, herniography was found to have a higher sensitivity and specificity than both ultrasound and computed tomography [ 27 ]. Herniography is an invasive procedure and not without its own complications; thus, ultrasound has become popular for the diagnosis of occult hernias in the United States. While ultrasound has a sensitivity of 86 % and a specificity of 77 % [ 27 ], it is operator dependent and requires some institutional expertise [ 28 ]. Despite being less sensitive and specific than other modalities, both CT and MRI of the groin can be performed to assess for inguinal hernias. Of these two tests, the MRI has less radiation exposure and a higher likelihood of discovering alternative causes of groin pain. For patients with histories consistent with sports injuries, osteitis pubis, or hip joint injury, MRI of the groin and/or hip is likely to provide the most high-yield information. Sports injuries have a variety of findings seen on MRI. An MRI is dependent on the radiology read, and a specializing sports injury MRI radiologist is often needed to get a thorough enough dictation. In skilled hands, patients with a true “sports hernia” can also be found to have a protrusion of the transversalis fascia on dynamic ultrasound [ 8 ]. Osteitis pubis can be diagnosed on MRI based on signs of inflammation at the pubic symphysis [ 29 ]. Hip joint injury such as stress fractures, labral tears, femoroacetabular impingement, and iliopsoas bursitis
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Brian P. Jacob · David C. Chen Bru
Page 5 and 6: The SAGES Manual of Groin Pain Bria
Page 7 and 8: Foreword Inguinal hernia repair is
Page 9 and 10: Contents Part I Primary Groin Pain
Page 11 and 12: Contents ix 22 Management of Inguin
Page 13: Contents xi 45 Value-Based Clinical
Page 16 and 17: xiv Editors and Contributors Jeffre
Page 18 and 19: xvi Editors and Contributors David
Page 20 and 21: xviii Editors and Contributors Greg
Page 22 and 23: xx Editors and Contributors David S
Page 24 and 25: 1. Introduction to Primary and Seco
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Page 36 and 37: 3. Complex Regional Pain Syndrome T
Page 46 and 47: 4. Chief Complaint of Groin Pain: H
Page 48 and 49: 4. Chief Complaint of Groin Pain…
Page 60 and 61: 42 C. Ma and A. Ramaswamy inguinal
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Page 66 and 67: 48 C. Ma and A. Ramaswamy 26. Aasva
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Page 70 and 71: 52 I.M. Daoud and K. Dunn low herni
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Page 76 and 77: 58 I.M. Daoud and K. Dunn 13. O’C
Page 78 and 79: 60 G.J. Mancini Occult Hernia Backg
Page 80 and 81: 62 G.J. Mancini Magnetic resonance
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86 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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35 Chronic Post-inguinal Herniorrha
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36. Sports Hernia with Adductor Ten
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464 C.G. DuCoin and G.R. Jacobsen P
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466 C.G. DuCoin and G.R. Jacobsen O
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468 J.A. Blatnik and A.S. Prabhu a
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470 J.A. Blatnik and A.S. Prabhu Fi
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472 J.A. Blatnik and A.S. Prabhu ma
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474 S. Towfigh Physical Exam The pa
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476 S. Towfigh The patient’s loca
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478 S. Towfigh Fig. 39.2. Diagram o
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480 S. Towfigh periphery. He is 2+
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482 S. Towfigh References 1. Matthi
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484 N.A. Al-Enazi and B.P. Jacob
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486 N.A. Al-Enazi and B.P. Jacob Fi
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488 N.A. Al-Enazi and B.P. Jacob pu
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42. Patient with Chronic Pelvic Pai
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42. Patient with Chronic Pelvic Pai
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43. Thoracolumbar Syndrome James A.
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43. Thoracolumbar Syndrome 497 The
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43. Thoracolumbar Syndrome 499 Groi
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44. Patient with Referred Hip Pain
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44. Patient with Referred Hip Pain
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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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