spine- related Groin pain

Transcription

1 spine- related Groin pain دانشگاه علوم پزشکی و خدمات بهداشتی درمانی تهران دانشکده پزشکی گروه پزشکی ورزشی مرکز تحقیقات پزشکی ورزشی دکتر رامین کردی متخصصص پزشکی ورزشی فلوشیپ اینترونشن ستون فقرات عضو هیات علمی دانشگاه علوم پزشکی

2 Outline

3 LBP & Hip pain c sign

4 In about 25 to 35% of patients multiple, causes for the chronic groin pain can be found.

5 Hip-spine Syndrome Osteoarthritis of the hip and degenerative lumbar spinal stenosis

6 Diagnostic hip block Fluoroscopic guided injections an extremely valuable diagnostic and therapeutic test to localise groin pain of intra-articular origin A positive response to an intraarticular injection = 90% reliable indicator of an intra-articular abnormality Vijay D. et al. Groin pain in athletes: a novel diagnostic approach SICOT J. 2015; 1: 16.

7 Groin pain in athletes: a novel diagnostic approach Vijay D. et al. SICOT J. 2015; 1: 16.

8 Spine related groin pain Sacroiliac joint pain Myofascial pain syndrome Facet joint pain Discogenic pain Disc protrusion

9 Sacral Iliac Joint Pain

10 Pain Distributions 10 asymptomatic volunteers, SIJ injection with contrast material (Fortin et al 1994 Spine;19: ).

11

12 Pain Drawing It is never above the level of L5 The presenting symptom is often described by the patient as sciatica. (Journal of Bodywork & Movement Therapies (2010) 14, 152e161)

13 Density of referral zones for sacroiliac joint pain is the least common referral zone; 4+ is the most common referral zone. (Dreyfuss P, Dreyer S. J Am Acad Orthop Surg 12: , 2004.)

14 Fortin s (One) finger test

15 Tenderness Palpation of the long dorsal sacro-iliac ligament (Vleeming et al., 1996, 2002).

16 Diagnostic Blocks A single diagnostic block Double diagnostic block using 2 different local anesthetics containing different durations of action. Pain Practice, Volume 10, Issue 5, only 22% of blind procedures resulted in intraarticular injectate spread. false-positive & false-negative Rosenberg JM, Quint TJ, de Rosayro AM. Clin J Pain. 2000;16:18 21.

17 Intra-articular injection of sacroiliac joint

18 Myofacial pain syndrome

19 Trigger Point, myofascial pain syndrome

20 Facet Joint Pain

21

22 Pain referral patterns, the most common referral patterns :the darkest (low back) to the lightest regions (flank and foot

23 Low back: L5 S1, L4 L5, L3 L4 Buttock: L5 S1, L4 L5, L3 L4 Lateral thigh: L5 S1, L4 L5, L3 L4, L2 L3 Posterior thigh: L5 S1, L4 L5, L3 L4 Greater trochanter: L5 S1, L4 L5, L3 L4, L2 L3 Groin: L5 S1, L4 L5, L3 L4, L2 L3, L1 L2 Anterior thigh: L5 S1, L4 L5, L3 L4 Lateral lower leg: L5 S1, L4 L5, L3 L4 Upper back: L3 L4, L2 L3, L1 L2 Flank: L1 L2, L2 L3 Foot: L5 S1, L4 L5

24 Diagnostic Blocks It is generally accepted in clinical practice that diagnostic blocks are the most reliable means for diagnosing l-z joints as pain generators. Numerous guidelines and reviews have asserted that intraarticular injections and facet joint medial branch blocks are equally effective in diagnosing l-z joint pain.

25 Disc related Pain

26 21 % of patients with lower lumbar disc degeneration or herniation have had associated symptoms of groin pain Yukawa Y, Kato F, Kajino G, Nakamura S, Nitta H. Groin pain associated with lower lumbar disc herniation. Spine (Phila Pa 1976). 1997;22(15): discussion 1740.

27 Lumbar Disc Degeneration Induces Persistent Groin Pain The patients without LBP suffered from groin pain and showed disc degeneration only at 1 level (L4-L5 or L5-S1) on magnetic resonance imaging. lidocaine into hip joints and examined pain provocation on discography, pain relief by anesthetic discoblock, Oikawa Y et al. Lumbar disc degeneration induces persistent groin pain. Spine (Phila Pa 1976) Jan 15;37(2):114-8.

28 Discogenic groin pain A 40-year-old patient showed left groin painwithout low back pain or radicular leg pain. (A) Magnetic resonance image showed 1-level disc degeneration at the L4-L5 level. (B) X-ray image did not show abnormality of hip joints. (C) Infi ltration of lidocaine into the patient s hip joint did not decrease the groin pain, discography induced pain provocation, and discoblock reduced pain. Oikawa Y et al. Lumbar disc degeneration induces persistent groin pain. Spine (Phila Pa 1976) Jan 15;37(2):114-8.

29 Disc Herniations L4 5, L5 S1, L1/L2 and S3/S4 levels. Spine related groin pain. Sagittal T2-weighted image of lumbar spine shows entrapped L5 root; a red arrow shows subarticular (foramenal) disc protrusion combined

30 Upper Lumbar Disc Herniations > 1-2% of all disc herniation L1-L2 and L2-L3 Clinical features were variable, and localized sensory change or pain was rarely demonstrated. J Korean Neurosurg Soc 48 : , 2010

31 Upper Lumbar Disc Herniations L1-L2 and L2-L3 41 patients J Korean Neurosurg Soc 48 : , 2010

32 Upper Lumbar Disc Herniations L1-L2 and L2-L3 41 patients J Korean Neurosurg Soc 48 : , 2010

33 Groin pain associated with lower lumbar disc herniation (L4-L5 and L5-S1) (4.1%) reported groin pain Yukawa Y et al. Spine (Phila Pa 1976) Aug 1;22(15):1736-9; discussion Groin pain associated with lower lumbar disc herniation.

34 Spondylolisthesis Lumbar Stenosis

35 Outline

36 سالمت و پیروز باشید