12-06-2013 1 Differential diagnosis in athletes with groin and hip pain Per Hölmich Sports Groin Pain Center Aspetar Orthopaedic and Sports Medicine Hospital Doha, Qatar & The Copenhagen Groin and Hip Research Center Arthroscopic Center Amager University of Copenhagen, Denmark Aspetar & Arthroscopic Center Amager Muscles reated to groin and hip • Adductor longus/brevis • Adductor magnus • Gracilis • Pectineus • Iliopsoas • Sartorius • Rectus femoris • Tensor Fascia Latae • Gluteus medius, minimus • Gluteus maximus • Piriformis and other external rotators • Hamstrings Aspetar & Arthroscopic Center Amager Codon, Am J Surg 1996 Gibbon, The Lancet 1999 Robinson et al; Skeletal Radiol. 2004 Davis et al BJSM 2012 Aspetar & Arthroscopic Center Amager Muscle, tendons and aponeuroses Aspetar & Arthroscopic Center Amager The anatomy of groin injuries - from a sports hernia point of view Muschaweck describes the abdominal wall biomechanically as - a matrix of tension bands that attach to the pubic bone & the muscle and fascia layers form a ‘‘slide bearing’’ - which is essential for an athlete’s mobility, including running, sprinting, jumping, and upper body rotation Minnich et al AJSM 2011 Aspetar & Arthroscopic Center Amager Aspetar & Arthroscopic Center Amager
9
Embed
340]) - IOC WORLD CONFERENCE · Davis et al BJSM 2012 Aspetar & Arthroscopic Center Amager Muscle, tendons and aponeuroses Aspetar & Arthroscopic Center Amager The anatomy of groin
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
12-06-2013
1
Differential diagnosis in athletes with
groin and hip pain
Per Hölmich
Sports Groin Pain Center
Aspetar Orthopaedic and Sports Medicine Hospital
Doha, Qatar
&
The Copenhagen Groin and Hip Research Center
Arthroscopic Center Amager
University of Copenhagen, Denmark
Aspetar & Arthroscopic Center Amager
Muscles reated to groin and hip
• Adductor longus/brevis
• Adductor magnus
• Gracilis
• Pectineus
• Iliopsoas
• Sartorius
• Rectus femoris
• Tensor Fascia Latae
• Gluteus medius, minimus
• Gluteus maximus
• Piriformis and other external
rotators
• Hamstrings
Aspetar & Arthroscopic Center Amager
Codon, Am J Surg 1996Gibbon, The Lancet 1999Robinson et al; Skeletal Radiol. 2004Davis et al BJSM 2012
Aspetar & Arthroscopic Center Amager
Muscle, tendons and aponeuroses
Aspetar & Arthroscopic Center Amager
The anatomy of groin injuries- from a sports hernia point of view
Muschaweck describes the abdominal wall
biomechanically as -
a matrix of tension bands that
attach to the pubic bone & the
muscle and fascia layers form a
‘‘slide bearing’’
- which is essential for an athlete’s
mobility, including running, sprinting,
jumping, and upper body rotation
Minnich et al
AJSM 2011
Aspetar & Arthroscopic Center Amager Aspetar & Arthroscopic Center Amager
12-06-2013
2
…greater trochanteric pain syndrome (GTPS) is
being advertised as a clinical entity that includes a number of disorders of the lateral peritrochanteric space of the hip, including
trochanteric bursitis, tears of the gluteus medius and minimus and external coxa saltans (snapping hip)
Athletic knee syndrome….
Athletic pubalgia….????
Aspetar & Arthroscopic Center Amager
Clinical entities for groin injuries
Very few diagnosis of the groin are clearly
established yet –
A systematic clinical approach to groin and hip pain in athletes was suggested in
2007 based on the relation of the pain to the anatomy
Utilising a number of specific and reliable tests –to identify a diagnostic pattern
leading to clinical entities
Hölmich et al BJSM 2004 & Hölmich BJSM 2007
Aspetar & Arthroscopic Center Amager
”Clinical Entity”
• The symptoms and clinical findings are related to a specific anatomical structure:
• Iliopsoas related groin pain
• Adductor related groin pain
• Inguinal related groin pain
Hölmich BJSM 2007
Aspetar & Arthroscopic Center Amager
The clinical entity approach has since been
implemented by several other authors
Ekstrand, Hägglund, Walden - UEFA-studies
AJSM, BJSM, SJMSS 2007-13
UEFA Football Doctor Education Programme 2013
Robinson P et al; Skeletal Radiol. 2004
Lovell G et al; CJSM 2006
Schilders et al; JBJS Am. 2007
Atkinson HD et al; Arch Orthop Trauma Surg 2009
Weir A et al BJSM 2009
Malliaras P et al BJSM 2009
Hanna C et al, JSMS 2010
Schilders et al AJSM 2013
Aspetar & Arthroscopic Center Amager
998 soccer players followed for 1 season • 58 groin injuries – all examined systematically
with the standardised technique
• 51% adductor-related
• 30% iliopsoas related
• 19 % inguinal related
• 68% in the dominant leg
• The duration of having both adductor- and inguinal-related injury is
4.56 times longer
• 24% had more than one clinical entity
• 39% had a traumatic onset of the groin injury
Hölmich et al (unpublished data)
Aspetar & Arthroscopic Center Amager
Further studies needed to develop the
clinical entity approach to groin injuries
• Combining the imaging and
the clinical entities
• Investigating the acute groin
entities
• Biomechanical evaluation
• Differentiating the clinical
entities into specific diagnosis
Aspetar & Arthroscopic Center Amager
12-06-2013
3
The known pain
• The patient should be asked, whether the pain inflicted by
the test is the pain, that usually is bothering the patient (the