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At least 235 records · Page 13Linked to original sources
PubMed2005

Secondary cleft sign as a marker of injury in athletes with groin pain: MR image appearance and interpretation.

PURPOSE: To determine whether the secondary cleft sign demonstrated in the symphysis pubis at magnetic resonance (MR) imaging is a marker of injury in athletes presenting with groin pain. MATERIALS AND METHODS: Ethics review board approval was not required for studies involving retrospective image or case record review; informed consent for review was not required. Eighteen male athletes (mean age, 24 years; age range, 19-32 years) were included for study. All patients underwent radiography and MR imaging (coronal fast spin-echo T1-weighted, transverse fast spin-echo T2-weighted, and coronal turbo short inversion time inversion-recovery [STIR] imaging) of the pelvis. Subsequent image-guided nonionic contrast material injection was followed by a 0.5% bupivacaine hydrochloride (1 mL) and methyprednisolone acetate (20 mg) injection into the central cleft of the symphysis pubis. Comparison was made between imaging findings at symphyseal cleft injection and appearances at preprocedure MR imaging, with specific reference to the presence of a secondary cleft. The sensitivity and specificity of MR imaging in demonstrating the secondary cleft sign were compared with those of the reference standard, imaging at symphyseal cleft injection. MR images from a reference group of 70 asymptomatic athletes who underwent STIR imaging of the pelvis were analyzed for evidence of a secondary cleft. RESULTS: Osteitis pubis was diagnosed in six patients on the basis of radiography and/or MR imaging. A secondary cleft was identified in 12 of 18 patients at MR imaging, was best visualized at coronal STIR imaging, and was confirmed in each patient during contrast material injection into the central physiologic symphyseal cleft. In no patient was a secondary cleft identified at symphyseal cleft injection and not identified at MR imaging (sensitivity and specificity, 100%). In each patient, the side of the secondary cleft corresponded to the side of symptoms that responded to local anesthetic and steroid injection. Four of the six patients with osteitis pubis had evidence of a secondary cleft. In one patient, a secondary cleft was not identified at MR imaging or symphyseal cleft injection, but adductor avulsion was identified at MR imaging. No evidence of a secondary cleft sign at MR imaging was identified in the reference group. CONCLUSION: The secondary cleft sign demonstrated at MR imaging is a marker of groin injury in athletes presenting with groin pain.

Adult↗
PubMedDate not supplied

Hip and groin injuries in athletes.

Although athletic injuries about the hip and groin occur less commonly than injuries in the extremities, they can result in extensive rehabilitation time. Thus, an accurate diagnosis and well-organized treatment plan are critical. Because loads of up to eight times body weight have been demonstrated in the hip joint during jogging, presumably even greater loads can occur during vigorous athletic competition. The available imaging modalities are effective diagnostic tools when selected on the basis of a thorough history and physical examination. Considerable controversy exists as to the cause and optimal treatment of groin pain in athletes, or the so-called "sports hernia." There has also been significant recent attention focused on intraarticular lesions that may be amenable to hip arthroscopy. This article briefly reviews several common hip and groin conditions affecting athletic patients and highlights some newer topics.

Acetabulum↗
PubMed2004

Laparoscopic repair of groin pain in athletes.

BACKGROUND: There has been increasing interest regarding the cause and treatment of groin pain in athletes. The most common finding is a deficiency of the posterior wall of the inguinal canal, often repaired with bilateral inguinal myorrhaphy. HYPOTHESIS: Laparoscopic repair will offer a shorter convalescent period and better results as compared with open myorrhaphy. STUDY DESIGN: Retrospective review of prospectively collected data. METHODS: Between October 1993 and October 2002, 131 athletes with groin pain unrelieved after 2 to 8 months of conservative management underwent bilateral laparoscopic repair with the transabdominal preperitoneal technique for hernias. In 123 (94%) patients, physical examination revealed a dilated external ring, unilateral or bilateral, of the inguinal canal, and in 8 patients (6%) it was normal. RESULTS: During laparoscopy, a deficiency of the posterior inguinal wall was seen in all athletes. All patients left the hospital 24 hours after the procedure, discontinued oral analgesics within 72 hours of surgery, and were back to full sporting activities within 2 to 3 weeks. Four patients (3%) complained of thigh pain. After a mean follow-up of 5 years (range, 4 months to 10 years), there was 1 recurrence (0.76%). CONCLUSIONS: Laparoscopic repair is an efficient method for the treatment of groin pain originating from a deficiency of the posterior inguinal wall, having fast recovery and excellent long-term results.

Adolescent↗
PubMedDate not supplied

Obturator nerve entrapment. A cause of groin pain in athletes.

Chronic groin pain in athletes is often difficult to diagnose and treat. There are many anatomic structures in the inguinal and groin region that have the potential to cause pain. We report 32 cases of a previously undescribed condition in athletes of "obturator neuropathy," a fascial entrapment of the obturator nerve where it enters the thigh. This condition represents a type of groin pain in athletes that is treatable by surgical means. There is a characteristic clinical pattern of exercise-induced medial thigh pain commencing in the region of the adductor muscle origin and radiating distally along the medial thigh. Needle electromyography demonstrates denervation of the adductor muscles. Surgical neurolysis treatment provides the definitive cure of this problem, with athletes returning to competition within several weeks of treatment. The surgical findings are entrapment of the obturator nerve by a thick fascia overlying the short adductor muscle. The role of conservative treatment in the management of this condition is unknown at present.

Adolescent↗
PubMed1988

Longstanding groin pain in athletes. A multidisciplinary approach.

In 21 male athletes (age 20 to 40 years) with longstanding unexplained groin pain, a multidisciplinary investigation was performed in order to reveal the underlying cause. These examinations included general surgery for detection of inguinal hernia and neuralgia, orthopaedic surgery for detection of adductor tenoperiostitis and symphysitis, urology for detection of prostatitis, radiology for performing herniography and plain film of the pelvic bones, nuclear medicine for isotope studies of the pubic bone and symphysis. In 19 patients there was a positive diagnosis for 2 or more of the diseases (10 patients had 2 diseases, 6 patients had 3 diseases, 3 patients had 4 diseases). Two patients had only signs of symphysitis. Our results show the complexity of longstanding groin pain in athletes. It also explains why therapy for one specific disease entity may fail. We conclude that this clinical setting demands the recruitment of a team with experience of different aspects of groin pain.

Adult↗
PubMed1995

Color Doppler sonography of groin complications following femoral artery catheterization.

Color Doppler sonography has proved to be an excellent technique for the evaluation of groin complications following femoral artery catheterization [1-4]. With the widespread use of fibrinolytic therapy, anticoagulants, and large-diameter vascular sheaths, a marked increase has been noted in the number of such complications [5, 6]. Accurate diagnosis of groin injuries is critical for establishing whether surgical or nonsurgical treatment is required. In this pictorial essay we review the color Doppler sonography findings of these complications, emphasizing unusual complications such as pseudoaneurysms coincident with arteriovenous fistulas, multilobulated pseudoaneurysms, ruptured pseudoaneurysms, and patent needle tracts. We also discuss the diagnostic pitfalls and mimics of groin injuries, including lymphadenopathy, varicosities, true aneurysms, and atypical but normal branch vessels.

Adult↗
PubMed2000

Gilmore's groin repair in athletes.

Incapacitating groin pain is a frequent problem among athletes and its etiology may be multifactorial. A specific clinical syndrome relating to injury to the lower abdominal wall has been described and successfully treated by O. J. Gilmore. This paper presents our results of 100 consecutive groin repairs in 85 young athletes using a diagnostic and therapeutic strategy similar to Gilmore's. Ninety-six percent of our patients returned to competitive sport within 15 weeks; we suggest that this is an appropriate therapeutic intervention for athletes who develop chronic incapacitating groin pain.

Adolescent↗
PubMedDate not supplied

Groin flap for coverage of upper extremity defects in Enugu, Nigeria.

BACKGROUND: Extensive tissue loss of the hand has remained a big challenge to the Plastic and Reconstructive Surgeon. The objective of this study is to review the use of pedicle groin flap for coverage of distal forearm and hand defects in our centre, and to find out problems of using the flap and make suggestions for improvement. METHOD: This is a retrospective study done using case records of patients treated with pedicle groin flaps for upper extremity defects at the National Orthopaedic Hospital Enugu from January 1999 to December 2004 (six year period). Information on biodata, clinical presentation, treatment, complications and outcome was extracted and analyzed using descriptive statistics. RESULTS: Thirteen (13) patient's case files met the inclusion criteria and were analyzed. There were seven (7) males and six (6) females with mean age ranges between 9 years and 42 years. Four (4) had distal forearm and nine (9) hand wound coverage's. Flap survival was very good to excellent in all cases and the outcome quite satisfactory. CONCLUSION: Use of pedicle groin flap for coverage of defects of the hand and distal forearm remains a very valuable treatment option in our environment.

Adolescent↗
PubMed2000

[Groin pain in athletes: role of magnetic resonance].

INTRODUCTION: Aim of our work was to evaluate the diagnostic role and potentials of Magnetic Resonance Imaging (MRI) in the study of groin pain in athletes and in the differential diagnosis among the pathological conditions that cause this syndrome. MATERIAL AND METHODS: MRI examinations were performed with a 1.5 T superconductive magnet, and a 0.2 T permanent magnet. Spin-Echo (SE) T1-w, PD, SE T2-w, Gradient-Echo (GE) T2-w and fat saturation sequences were used, on axial, sagittal and coronal scan planes. We performed MRI on twenty-five athletes (22 men and 3 women; age range 17 to 32 years) with chronic groin pain of questionable origin who had been complaining of it for at least 6 months. In 22 cases, radiographs were available; Computed Tomography (CT) had been performed in 3 cases and Ultrasound (US) in 7 cases. Nine patients were submitted to MRI after the symptoms had disappeared. RESULTS: In all patients, MRI provided an accurate depiction of pubic bone alterations and of adjacent myotendinous structures. In 14 cases, osteitis pubis was diagnosed, which was bilateral in 2 cases only (muscular asymmetry of the rectus abdominis was found in 4 of these patients); 4 patients had myotendinous posttraumatic changes (1 hematoma of the psoas muscle and 3 injuries of the abductor muscles of the thigh); 4 patients presented isolated dysmetria of rectus abdominis muscles, with unilateral involvement of the sacroiliac joint in 1 patient; 3 patients had inguinal hernia, surgically confirmed in all cases. DISCUSSION: Osteitis pubis, intended as reactive intraspongiuos edema of the pubic bones, is the most frequent cause of groin pain in athletes. In the early diagnostic phases, both plain films and CT may be negative or not specific. On the other hand, MRI has always proved to be a valuable diagnostic technique in detecting the osteitic change as an area of low signal intensity on T1-w images and of high and homogeneous signal intensity on T2-w scans without fat suppression. Dysmetria of the straight muscles of the abdomen, which may be associated, is always well depicted by MRI on axial planes. Both posttraumatic and dysmetric changes of the muscular structures adjacent to the pubis are well documented by US and MRI. The latter, however, thanks to its multiplanar capabilities, allows better spatial assessment of the alteration, especially if located at peri-insertional level. Possible associated diseases such as the involvement of the sacroiliac joints are also well shown by MRI. Inguinal hernias are easily demonstrated by MRI, which allows the direct visualization of the hernial sac within the inguinal canal. CONCLUSIONS: In our experience, only MRI can permit an accurate and early diagnosis of the different sport-related pubic conditions. MRI is also a valuable tool in monitoring the alterations with reference to their response to treatment, which may also help bring the athletes back to their activities.

Abdominal Muscles↗
PubMed2001

[Groin pain in sport].

Pain syndromes in the groin are common in people involved in sports such as soccer, handball etc. Approximately 2.5% of all sport related injuries are in the pelvic area. Soft tissue injuries are the most common cause for groin pain in athletes. The majority of conditions will gradually disappear with rest and symptomatic treatment. Symptoms are often vague and diffuse. Therefore, high index of suspicion, thorough knowledge of the anatomy and multidisciplinary approach is needed for diagnosing and treating. Early diagnosis will reduce morbidity. Managing chronic pain is difficult. Groin injuries are some of the most challenging injuries in the field of sports medicine.

Athletic Injuries↗
PubMed1992

Tendon and muscle injuries in the groin area.

Groin injuries in athletes are being recognized as one of the most difficult problems in sport. The symptoms associated with chronic groin injuries are often diffuse and uncharacteristic. These injuries usually constitute a major diagnostic and therapeutic challenge, the success of which depends on a correct diagnosis. It is necessary to establish a broad, differential background, and therefore, this article includes a broad description of groin injuries.

Athletic Injuries↗
PubMed2004

Infrascrotal, perineal, femorofemoral bypass for arterial graft infection at the groin.

HYPOTHESIS: Infrascrotal, perineal, femorofemoral bypass is an acceptable procedure for treating infection of a prosthetic arterial graft limited to a unilateral groin. DESIGN: A consecutive sample clinical study with a mean follow-up of 29 months. SETTING: The surgical department of an academic tertiary care center and an affiliated secondary care center. PATIENTS: Nineteen patients with a mean age of 68 years with prosthetic graft infection at the outflow anastomosis on a femoral artery at the Scarpa triangle underwent an infrascrotal, perineal, femorofemoral bypass, with excision of the graft material limited at the groin. The recipient artery was the profunda femoris artery in 12 cases, the superficial femoral in 5, and the distal common femoral artery in 2. MAIN OUTCOME MEASURES: Cumulative survival, recurrence of sepsis, primary graft patency, and limb salvage rates expressed by standard life-table analysis. RESULTS: Postoperative mortality rate was 5%. Cumulative (SE) survival rate was 65% (11.6%) at 3 years. Cumulative (SE) rate of freedom from recurrent sepsis was 88% (8.6%) at 3 years. Cumulative (SE) primary patency and limb salvage rates were 86% (9.4%) and 91% (7.9%), respectively, at 3 years. CONCLUSION: Femorofemoral bypass with an infrascrotal perineal approach is a valuable procedure for the treatment of femoral arterial graft infection limited at a unilateral groin.

Adult↗
PubMed1991

Survival after groin dissection for malignant melanoma.

Groin dissection was performed in 158 patients with malignant melanoma (superficial dissection, 76 patients; radical dissection, 82 patients). Of 63 patients with palpable nodes, 57 patients (90%) had histologic involvement. Of 93 patients with nonpalpable nodes, 31 patients (33%) had histologically positive nodes. The 5-year survival rate for patients with histologically negative nodes (n = 69) was 77%; the 5-year survival rate for patients with histologically positive nodes (n = 89) was 43%. The respective 5-year disease-free survival rates were 72% and 34%. Of 57 patients with palpable, positive inguinal nodes, 21 patients (37%) had involvement of the deep nodes. Of 31 patients with nonpalpable, histologic involvement of the inguinal nodes, six patients (19%) had or developed involvement of the deep nodes. One of two patients with uncertain clinical status of the nodes preoperatively had positive deep nodes. In prophylactic node dissection, frozen section of the inguinal group of the nodes does not provide a reliable method, because of sampling errors, in determining microscopic involvement of the nodes and in deciding whether a superficial or radical groin dissection is to be done. For patients with positive nodes the 5-year survival rate was 48% when only the inguinal group was involved and was 28% when both inguinal and deep nodes were involved; the respective 5-year disease-free survival rates were 39% and 20%. Survival after therapeutic groin dissection may partly depend on the thoroughness of the procedure. Patients who have positive, deep nodes and who are undergoing an incontinuity dissection of the inguinal, iliac, and obturator nodes have an appreciable 5-year survival rate.

Female↗
PubMed1991

Preperitoneal herniorrhaphy for the acutely incarcerated groin hernia.

Elective preperitoneal or posterior repair for recurrent groin hernias and primary femoral hernias has been shown to be a technically advantageous approach. In addition to the ease of inguinal floor and femoral canal assessment, scar tissue from prior anterior herniorrhaphy can be avoided. The emergency management of the acutely incarcerated or strangulated hernia of the groin using this approach has not been addressed. During a 30-month period, all patients with a diagnosis of acute incarceration of a groin hernia (n = 28) were surgically managed using either the anterior approach (AA) (n = 14) or the preperitoneal approach (PA) (n = 14). Two patients with strangulated intestine in the AA group required an additional midline incision for bowel evaluation and resection. Intestinal evaluation was easily accomplished through the same incision in four patients in the PA group. The preperitoneal approach also allowed proximal control of incarcerated or strangulated viscera, thus avoiding excessive manipulation of gangrenous or necrotic intestine, potential spillage of infected contents into the peritoneal cavity, and entry of bacteria, toxins, potassium, and the metabolic waste products of anaerobic metabolism into the systemic circulation during hernia reduction. There have been no recurrences in either group, and minor complications, such as wound infection and cellulitis, in the two groups are not statistically different.

Adult↗
PubMed1981

Positive contrast herniography in adult patients with obscure groin pain.

To evaluate its clinical benefit in adults, herniography was used in 73 patients with clinically unexplained groin pain. Hernias were demonstrated on the side with symptoms in 26 patients (36%). Relief of groin pain was registered in 16 of 17 patients who subsequently underwent operation. We consider herniography to be of value in the examination of adult patients with clinically unclear groin pain.

Adult↗
PubMedDate not supplied

Groin lymphorrhea postoperative nuisance.

Lymphorrhea is defined as the flow of lymph from disrupted lymphatic channels that drains externally or is contained within a wound. It complicates approximately 2% of vascular incisions in the groin. Of 116 patients who underwent different arterial reconstructions involving 186 groin wounds, lymphorrhea developed in 4 patients (3.4%) including 4 groins (2.1%). They have been managed in the Division of Vascular Surgery at King Khalid University Hospital (KKUH) in Riyadh, during a 3-year period ending in February 1996. There were 105 (90.5%) males and 11 (9.5%) females. The ages ranged from 32 to 96 years with a mean age of 63 years. All the 4 cases complicated with lymphorrhea were managed conservatively for a period of three to five weeks. In 2 cases, the lymphatic leak stopped and the patients discharged without other local complications. In the other 2 cases, lymphatic leakage stopped immediately and permanently following direct surgical ligation. The use of isosulphane blue for localization of the site of the lymphatic leak was a simple, reliable and accurate method during wound exploration. Follow-up of all cases for 6 months showed no recurrence, no sepsis and patent vascular graft.

Adult↗
PubMed1997

The utility of ultrasonography in the evaluation of groin masses: a case report.

Surgeons are often faced with the evaluation and management of groin masses. In most cases, an accurate history and physical examination will establish a diagnosis. Ultrasonography is being increasingly used in the evaluation of surgical problems. A case is presented in which bedside ultrasound was utilized in the evaluation of a large, symptomatic left inguinal mass found to be a synovial cyst on exploration. The differential diagnosis of cystic groin lesions and the impact of ultrasonography on diagnosis is reviewed with emphasis on synovial cysts. Surgeon-directed ultrasonography is an asset in the diagnosis of some patients with groin masses and may assist in the identification of those lesions requiring prompt operative intervention.

Aged↗
PubMed1998

[Topographic anatomic study of cells transplanted from the groin region].

We performed 25 fresh cadaver dissections to describe the anatomy of the superficial and deep circumflex iliac artery and the superficial inferior epigastric artery how they can be used as donor vessels for the free transfer of groin flaps and for living iliac bone. With the injection of ink the capillary region of these vessels in the bone (iliac crest), the muscle (internal oblique muscle) and skin (groin and thigh) was stained. The superficial and deep circumflex iliac artery are the main supply vessels of the groin and thigh, they can be found in 96% and 100% of the cases. The venous drainage of this region follows from a superficial (superficial circumflex iliac vein) and a deep venous system (Vv. comitantes accompanying the arterial branches). Both venous systems can always be found. The superficial circumflex iliac artery only supplies the skin and is the main donor vessel for skin and soft tissue transplants. The deep circumflex iliac artery supplies the pelvic bone, the internal oblique muscle and a small constant area of skin above the iliac crest. Bone, bone-muscle and bone-muscle and skin transplants can be obtained with this donor vessels. To enlarge the skin area the two arterial branches can be combined in one transplant. With an average vessel diameter of 1.5 mm (superficial circumflex iliac artery) and 3 mm (deep circumflex iliac artery) both vessels can very well be used for microvascular transplantation. These different tissues (muscle, bone, skin) can be obtained in adequate size and form struct composite defects in the upper aerodigestive tract.

Capillaries↗