Groin Pain Syndrome : A Multidisciplinary Guide to Diagnosis and Treatment

"This book provides accurate descriptions of the injuries responsible for groin pain, which tend to occur in association with particular sports. The approach is multidisciplinary, ensuring that the book will be of broad appeal, and the focus is especially on epidemiology, etiology, and possible treatment options. Throughout, care has been taken to depict the state of the art in this constantly evolving field. A new classification of groin pain syndrome is presented, and the coverage encompasses hip, visceral, tendon/muscle, bone, and neurologic pathology. In addition, guidance is provided in selection of the rehabilitation program that will best meet the patient's needs, taking into account individual circumstances. Groin pain is among the most prevalent lower limb symptoms. The pain may occur immediately after an injury or develop gradually and is often exacerbated by continued use of the injured area. In presenting the latest knowledge on groin pain syndrome and its management, this book will be of value to a range of practitioners, including sports medicine specialists, primary care providers, urologists, orthopedists, and physiatrists."--Prové de l'editor Foreword 5 Preface 6 Contents 8 Part 1: Introduction 10 1: Classification and Differential Analysis of Groin Pain Syndrome 11 1.1 Introduction 11 1.2 The Groin Pain Syndrome Italian Consensus Classification 12 1.2.1 Summary of the First Document: Diagnostic Taxonomy Document Consensus 12 1.2.2 Summary of the Second Document: Clinical Semeiotics Document Consensus 15 1.2.2.1 First Category: Specific Test for Abductor Muscles 15 1.2.2.2 Second Category: Specific Test for Abdominal Muscles 15 1.2.2.3 Third Category: Specific Test for the Hip Joint 16 1.2.2.4 Fourth Category Clinical Evaluation of Inguinal Diseases 16 1.2.3 Summary of the Second Document: Imaging Document Consensus 16 References 18 2: Inguinal Region Anatomy 20 2.1 Introduction 20 2.2 The Abdominal Wall 20 2.3 The Inguinal Canal 21 2.4 The Pubic Symphysis 21 2.5 The Hip 21 2.6 The Adductor Compartment 22 References 23 3: Physiology and Biomechanics 25 3.1 Introduction 25 3.2 Hip Joint Function 25 3.3 Physiology of the Hip 26 3.4 Biomechanics and Movement 26 3.5 Force Loading of the Hip 27 3.6 Hip Function During Gait 28 References 29 4: Radiologic Diagnosis 30 4.1 Imaging Techniques 30 4.2 Imaging of Common Hip and Groin Injuries in the Athlete 32 4.3 Hip Pathology 32 4.3.1 Femoroacetabular Impingement 32 4.3.2 Acetabular Labral Tear 34 4.3.3 Loose Bodies 36 4.4 Soft Tissue Injuries of the Hip and Groin in the Athlete 36 4.4.1 Adductor-Rectus Femoris—Hamstring Injuries 36 4.4.2 Quadriceps Contusions: Hip Pointers—Morel-Lavallée Lesion 38 4.4.3 Weakness of the Inguinal Canal Wall 38 4.5 Skeletal Injuries 41 4.5.1 Apophyseal Avulsions of the Hip and Pelvis in Adolescents 41 4.5.2 Stress Fractures of the Hip and Pelvis 43 4.5.3 Osteitis Pubis 44 References 45 Part 2: Hip Pathology 48 5: Femoroacetabular Impingement 49 5.1 Introduction 49 5.2 Clinical Evaluation 52 5.3 Surgical Technique 53 5.3.1 Pincer FAI 53 5.3.2 Cam FAI 54 5.4 Complications 55 5.5 Outcome 55 References 56 6: Acetabular Labral Tear 58 6.1 Introduction 58 6.2 Anatomy, Physiology 58 6.3 Labral Tear Diagnosis: Rupture Classification 60 6.4 Acetabular Labral Tears: Treatment 61 References 62 7: Pathology of Central Compartment 63 7.1 Synovial Pathologies 63 7.1.1 Synovial Chondromatosis 63 7.1.2 Villonodular Synovitis 65 7.1.3 Mechanical or Inflammatory Synovitis 66 7.1.4 Medial Synovial Fold Pathology 66 7.2 Septical Arthritis 66 7.3 Foreign Bodies 66 7.4 Ligamentum Teres Pathology 67 7.4.1 Pathological Plicae 67 7.4.2 Ligamentum Teres Trauma 67 7.4.3 Micro-Instability 68 7.5 Coxarthrosis 69 References 70 8: Hip Cartilage Lesions 72 8.1 Introduction 72 8.2 Pathogenesis 72 8.3 Clinic 73 8.4 Classification 73 8.5 Imaging 74 8.6 Treatment 75 8.7 Outcome 77 References 78 9: Extra-articular Hip Pathology 80 9.1 Introduction 80 9.2 External Snapping Hip 80 9.2.1 Physical Examination 81 9.2.2 Imaging 81 9.2.3 Treatment 81 9.2.4 Surgical Technique 82 9.2.5 Outcome 83 9.3 Internal Snapping Hip 83 9.3.1 Anatomy 83 9.3.2 Diagnosis 84 9.3.3 Imaging 84 9.3.4 Conservative Treatment 84 9.3.5 Surgical Technique 85 9.3.6 Postoperative Rehabilitation 86 9.3.7 Outcome 86 References 87 Part 3: Visceral Pathology 88 10: Inguinal Hernia and Other Types of Hernia: Diagnostic and Therapeutic Approach 89 10.1 Epidemiology 89 10.2 Diagnosis 89 10.3 Classification 90 10.3.1 Indications for Treatment 90 10.4 Surgery 91 10.4.1 Femoral Hernia [25, 26] 92 10.4.2 Obturator Hernia [10, 11] 92 10.4.3 Spigelian Hernia [12] 92 10.4.4 Supravesical Hernia [13] 92 References 93 11: Urogenital Pathology 94 11.1 Introduction 94 11.2 Prostatic Diseases 94 11.2.1 Prostatitis 94 11.3 Scrotal Diseases 96 11.3.1 Testis and Epididymis Pathology 96 11.3.1.1 Spermatocele 97 11.3.2 Varicocele 97 11.3.3 Hydrocele 97 11.3.4 Torsion of the Spermatic Cord 97 11.4 Kidney Diseases 97 11.4.1 Kidney and Ureteral Stone 97 References 98 Part 4: Tendon/Muscle Pathology 99 12: Sports Hernia: Diagnostic and Therapeutic Approach 100 12.1 Aetiopathogenesis 100 12.2 Symptomatology and Physical Findings 101 12.3 Instrumental Diagnosis 102 12.4 Treatment 102 References 103 13: Sports Hernia: A Comparison of the Different Surgical Techniques 105 13.1 Open All-Suture Repair 106 13.1.1 Anatomical Background 106 13.1.2 Surgical Technique 106 13.1.3 Results 106 13.2 Minimal Repair Technique 106 13.2.1 Anatomical Background 106 13.2.2 Surgical Technique [7] 106 13.2.3 Results 107 13.3 Open with Anterior Mesh Repair and Combined Adductor Release If Needed 107 13.3.1 Anatomical Background 107 13.3.2 Surgical Technique 107 13.3.3 Results 108 13.4 Laparoscopic Repair with Mesh (Transabdominal Preperitoneal, Totally Extraperitoneal) 108 13.4.1 Anatomical Background 108 13.4.2 Surgical Technique 108 13.4.3 Results 109 13.5 Inguinal Ligament Release + Mesh (Lloyd Release Procedure) 109 13.5.1 Anatomical Background 109 13.5.2 Surgical Technique [21] 110 13.5.3 Results 110 13.6 Key Points Summary 110 13.7 Fixation 110 References 111 14: Adductor and Upright Abdominal Tendinopathy 112 14.1 Introduction 112 14.2 Clinical Assessment and Diagnosis 113 14.3 Management 116 14.4 Prevention Programs 118 References 118 15: Iliopsoas Tendinopathy 120 15.1 Introduction 120 15.2 Anatomy 120 15.3 Symptoms and Clinical Examination 121 15.4 Differential Diagnosis 123 15.5 Imaging 124 15.6 Therapy 124 References 126 Part 5: Bone Pathology 127 16: Osteitis Pubis 128 16.1 Epidemiology 128 16.2 Aetiopathogenesis 129 16.3 Anatomy 129 16.4 Signs and Symptoms 130 16.5 Diagnosis 131 16.6 Treatment 132 References 133 Part 6: Neurologic Pathology 134 17: Nerve Entrapment Syndromes 135 17.1 Anatomy 135 17.1.1 Ilioinguinal and Iliohypogastric Nerve 135 17.1.2 Genitofemoral Nerve 136 17.1.3 Obturator Nerve 136 17.1.4 Lateral Femoral Cutaneous Nerve 138 17.2 Clinical 138 17.3 Management 139 References 145 Part 7: Rehabilitation 147 18: Conservative Rehabilitation Treatment in Groin Pain Syndrome 148 18.1 Introduction 148 18.2 Conservative Treatment in Tendon and Muscle Pathology 149 18.3 Conservative Management of Sport Hernia 151 18.4 Conservative Management of Femoroacetabular Impingement 153 References 155 19: Postsurgical Rehabilitation: FAI 157 19.1 Introduction 157 19.2 Current Concepts of Rehabilitation 157 19.3 Weight-Bearing Status and Range of Motion 158 19.4 Rehabilitation Phases 158 19.4.1 Phase I 158 19.4.2 Phase II 159 19.4.3 Phase III 160 19.4.4 Phase IV 161 19.5 Patient-Reported Outcome 162 References 162 20: Postsurgical Rehabilitation: Hernioplasty 163 References 168 21: Postsurgical Rehabilitation: Tendon Surgery 169 21.1 Introduction 169 21.2 Surgical Techniques and Complications 170 21.3 Rehabilitation Protocols 170 21.3.1 Phase I 170 21.3.2 Phase II 172 21.3.3 Phase III 172 References 173 Part 8: Conclusion 174 22: Groin Pain Syndrome: A Final Assessment of the State of the Art 175 22.1 A Controversial Pathology 175 22.2 The Various Classification Attempts 175 22.3 The Consensus Conference Era 176 22.4 Future Directions 176 References 178 Front Matter....Pages i-x Front Matter....Pages 1-1 Classification and Differential Analysis of Groin Pain Syndrome....Pages 3-11 Inguinal Region Anatomy....Pages 13-17 Physiology and Biomechanics....Pages 19-23 Radiologic Diagnosis....Pages 25-42 Front Matter....Pages 43-43 Femoroacetabular Impingement....Pages 45-53 Acetabular Labral Tear....Pages 55-59 Pathology of Central Compartment....Pages 61-69 Hip Cartilage Lesions....Pages 71-78 Extra-articular Hip Pathology....Pages 79-86 Front Matter....Pages 87-87 Inguinal Hernia and Other Types of Hernia: Diagnostic and Therapeutic Approach....Pages 89-93 Urogenital Pathology....Pages 95-99 Front Matter....Pages 101-101 Sports Hernia: Diagnostic and Therapeutic Approach....Pages 103-107 Sports Hernia: A Comparison of the Different Surgical Techniques....Pages 109-115 Adductor and Upright Abdominal Tendinopathy....Pages 117-124 Iliopsoas Tendinopathy....Pages 125-131 Front Matter....Pages 133-133 Osteitis Pubis....Pages 135-140 Front Matter....Pages 141-141 Nerve Entrapment Syndromes....Pages 143-154 Front Matter....Pages 155-155 Conservative Rehabilitation Treatment in Groin Pain Syndrome....Pages 157-165 Postsurgical Rehabilitation: FAI....Pages 167-172 Postsurgical Rehabilitation: Hernioplasty....Pages 173-178 Front Matter....Pages 155-155 Postsurgical Rehabilitation: Tendon Surgery....Pages 179-183 Front Matter....Pages 185-185 Groin Pain Syndrome: A Final Assessment of the State of the Art....Pages 187-190 "This book provides accurate descriptions of the injuries responsible for groin pain, which tend to occur in association with particular sports. The approach is multidisciplinary, ensuring that the book will be of broad appeal, and the focus is especially on epidemiology, etiology, and possible treatment options. Throughout, care has been taken to depict the state of the art in this constantly evolving field. A new classification of groin pain syndrome is presented, and the coverage encompasses hip, visceral, tendon/muscle, bone, and neurologic pathology. In addition, guidance is provided in selection of the rehabilitation program that will best meet the patient's needs, taking into account individual circumstances. Groin pain is among the most prevalent lower limb symptoms. The pain may occur immediately after an injury or develop gradually and is often exacerbated by continued use of the injured area. In presenting the latest knowledge on groin pain syndrome and its management, this book will be of value to a range of practitioners, including sports medicine specialists, primary care providers, urologists, orthopedists, and physiatrists."--Prové de l'editor