Doc, I've done my groin. Groin Pain. Peter Brukner. Doc, I've done my groin 1. acute chronic

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Rolf Watson
6 years ago
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1 Doc, I've done my groin Peter Brukner Associate Professor in Sports Medicine Centre for Sports Medicine Research and Education School of Physiotherapy 9/22/2006 The University of Melbourne Groin Pain acute chronic Doc, I've done my groin 1

2 Acute groin pain adductor muscle strain Doc, I've done my groin 2

3 Chronic groin pain common AFL, soccer kicking change of direction Doc, I've done my groin 3

4 The Footballer s Groin adductor tendinitis footballers hernia conjoint tendon posterior wall weakness Gilmore s groin obturator nerve entrapment tear of external oblique osteitis pubis Other Causes stress fractures pubic ramus neck of femur psoas syndrome hip joint labral tear synovitis osteoarthritis referred pain Lovell cases of groin pain incipient hernia 95 50% adductor lesions 36 19% osteitis pubis 26 14% pubic instability 8 4% Iliopsoas injury 5 3% ilioinguinal nerve 5 3% referred pain 4 2% hip lesions 3 1% stress fracture 2 1% Doc, I've done my groin 4

5 Adductor Tendinopathy pain & tender adductor attachment tenoperiostitis tight adductor tendon soft tissue treatment? corticosteroid injection tendon release Footballer s Hernia sportsman s hernia incipient hernia conjoint tendon tear posterior inguinal wall weakness Gilmore s groin Conjoint Tendon Tear the Adelaide disease formed by internal oblique and transversus muscles uniting in a common tendinous insertion at the pubic crest and extending along the iliopectineal line biopsy NAD (Lovell et al) Doc, I've done my groin 5

6 Posterior Inguinal Wall Weakness chronic groin pain poorly localised kicking sports normal bone scan? positive peritoneogram surgery Gilmore s Groin torn external oblique aponeurosis causes dilatation of the superficial inguinal ring torn conjoint tendon dehiscence between the inguinal ligament and conjoint tendon Tear of External Oblique ice hockey players tear of ext oblique aponeurosis ilioinguinal nerve entrapment gradual onset dull ache Doc, I've done my groin 6

7 Obturator Nerve Entrapment fascial entrapment of obturator nerve 4% of chronic groin pain at OPSMC exercise-related pain proximal groin radiating to anterior thigh Doc, I've done my groin 7

8 Obturator Nerve Entrapment examine post-exercise weakness of resisted adduction numbness over distal medial thigh needle EMG surgery Doc, I've done my groin 8

9 Osteitis Pubis stress injury to bone usually insidious onset pain in adductor region central tenderness one of worst injuries in AFL prolonged recovery 4-6 months hidden injury Osteitis Pubis pain during exercise pain/stiffness morning after squeeze test adductor muscle guarding stress tests Doc, I've done my groin 9

10 Early Warning Signs tight/stiff during or after activity loss of acceleration vague discomfort deceleration loss of maximal sprinting speed loss of distance with kick Palpation pubic symphysis superior pubic ramus Investigations X ray bone scan CT scan MRI Doc, I've done my groin 10

11 X ray moth -eaten appearance pubic symphysis Bone Scan increase uptake central or unilateral Doc, I've done my groin 11

12 CT scan widening of pubic symphysis cystic changes erosions Doc, I've done my groin 12

13 MRI Verrall et al bone marrow oedema erosions and cysts ligament hypertrophy May Progress to stress fracture pubic instability Management stop playing reduce adverse loads exercise therapy and motor learning gradually resume running & kicking 4-6 month rehab Doc, I've done my groin 13

14 Stress Fracture gradual onset groin pain risk factors Stress Fracture pubic ramus Doc, I've done my groin 14

15 Stress Fracture neck of femur compression distraction Doc, I've done my groin 15

16 Psoas Syndrome anterior groin pain psoas stretch resisted movement neural component Doc, I've done my groin 16

17 Psoas Syndrome thoraco-lumbar junction stretch soft tissue treatment psoas sheath injection Hip Joint local pain radiates to anterior thigh no local tenderness quadrant test Doc, I've done my groin 17

18 Labral Tear? common acute or chronic onset MRI arthroscopy Referred Pain lumbar spine sacroiliac joint Doc, I've done my groin 18

19 Future Research hip labral tears incidence MRI findings relationship to LBP Future Research osteitis pubis MRI findings evaluate role of TA evaluation of treatment case series RCT Doc, I've done my groin 19

Approaching the Irritable Hip antero-medial hip and groin pain

Approaching the Irritable Hip antero-medial hip and groin pain Dr John P Best, FACSP, FFSEM Sports and Exercise Medicine Conjoint Lecturer UNSW Antero-medial Hip and Groin Pain Incidence and Causes 5-10%