DOCSLIB.ORG

Printable Notes

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Printable Notes 12/9/2013 Diagnosis and Treatment of Hip Pain in the Athlete History Was there an injury? Pain Duration Location Type Better/Worse Severity Subjective Jonathan M. Fallon, D.O., M.S. assessment Shoulder Surgery and Operative Sports Medicine Sports www.hamportho.com Hip and Groin Pain Location, Location , Location 1. Inguinal Region • Diagnosis difficult and 2. Peri-Trochanteric confusing Compartment • Extensive rehabilitation • Significant risk for time loss 3. Mid-line/abdominal Structures • 5‐9% of sports injuries 3 • Literature extensive but often contradictory 1 • Consider: 2 – Bone – Soft tissue – Intra‐articular pathology Differential Diagnosis Orthopaedic Etiology Non‐Orthopaedic Etiology Adductor strain Inguinal hernia Rectus femoris strain Femoral hernia Physical Examination Iliopsoas strain Peritoneal hernia Rectus abdominus strain Testicular neoplasm Gait Muscle contusion Ureteral colic Avulsion fracture Prostatitis Abdominal Exam Gracilis syndrome Epididymitis Spine Exam Athletic hernia Urethritis/UTI Osteitis pubis Hydrocele/varicocele Knee Exam Hip DJD Ovarian cyst SCFE PID Limb Lengths AVN Endometriosis Stress fracture Colorectal neoplasm Labral tear IBD Lumbar radiculopathy Diverticulitis Ilioinguinal neuropathy Obturator neuropathy Bony/soft tissue neoplasm Seronegative spondyloarthropathy 1 12/9/2013 Physical Examination • Point of maximal tenderness Athletic Pubalgia – Psoas, troch, pub sym, adductor – Gilmore’s groin (Gilmore • C sign • ROM 1992) • Thomas Test: flexion contracture – Sportsman’s hernia • McCarthy Test: labral pathology (Malycha 1992) • Impingement Test – Incipient hernia 3 • Clicking: psoas vs labrum • Resisted SLR: intra‐articular – Hockey Groin Syndrome – • Ober: IT band Slapshot Gut • FABER: SI joint – Ashby’s inguinal ligament • Heel Strike: Femoral neck • Log Roll: intra‐articular enthesopathy • Single leg stance –Trendel. Location, Location , Location Athletic Pubalgia - Natural History 1. Inguinal Pain – Intra-articular -Femoroacetabular Impingment Disabling lower abdominal/inguinal pain at extremes -Flexor Strain of exertion -Hernia Pain at rectus insertion, progresses despite treatment Pain abates with cessation of activity 2. Peri-Trochanteric Compartment 3 Hyperextension injury with a hyper‐abduction of the -Trochanteric Bursitis 1 thigh -Piriformis Syndrome 2 Male predominant injury 3. Mid-Line Structures -Ramus Fx, Osteitis Pubis -Athletic Pubalgia, Hernia Athletic Pubalgia Midline Pain ‐ Anatomy Meyers et al AJOSM Viscera ‘00 Bony Architecture Chronic inguinal or Muscle layers pubic area pain Noted on exertion only 3 dDx: Not explainable by a Athletic Pubalgia palpable hernias Osteitis Pubis Not explainable by Stress fracture other medical Tendonitis diagnosis 2 12/9/2013 Physical Exam Inguinal “Hip” Pain Tender to Palpation over Peripubic Area, Symphysis 1. Hernia Pubis, or Adductor Area 2. AVN No Palpable Hernia 3. Internal Snapping Hip 4. Intra-articular Snapping Hip Pain with Resisted Adduction •Loose Bodies or Situps •Synovial Chondromatosis 1 •Lesions of the Ligamentum Teres Tight Hamstrings or Limited •Labral Tear Hip Motion 5. Femoral-Acetabular Impingement Neuro Exam Normal Osteitis Pubis Inguinal & Femoral Hernias Inflammatory Process of Symphysis Inguinal Hernia Femoral Hernia Persistent Processus Under Inguinal Ligament, in Microtrauma from Athletic Activity Vaginalis Space Medial to the Femoral Kicking and Running Groin Pain Radiating to Vein in the Femoral Triangle Occurs in: Upper Thigh Long Distance Runners Worse with Valsalva Tender to Palpation and Mass can be Felt Soccer Players Weight Lifters Diffrential Diagnosis: Diagnosis Requires High Fencers Epididymitis Scrotal Abscess Index of Suspicion Football Players Testicular Torsion Imbalance Abdominals and Hip Adductors Varicocele Open Surgical Repair Pain with passive abduction and resisted Spermatocele adduction Hydrocele Surgical Repair Often Insidious but Can Be Acute Endoscopic vs. Open Pelvic Stress Fractures Repetitive Motion such as Running Avascular Necrosis Pain Subsides with Rest Etiology Rami Trauma No Limitation in Hip Motion Pain Standing Unsupported on Sickle Cell Affected Leg (Positive Standing Sign) Steroids Sacrum Distance runners Binge Drinking Pain with Weight Bearing Idiopathic Femoral Neck Limited Internal Rotation of Hip Can Be Bilateral (IMAGE BOTH SIDES) AVN is the final common pathway 3 12/9/2013 Avascular Necrosis FAI Presentation Physical exam Insidious Onset Limited flexion • Impingement Sign Activity Related • Pain when maximally flexed and internally rotated Progressive • 87% sensitivity • McCarthy’s Sign • Pain with full extension of a flexed and externally rotated hip • Anterior labrum (82% sensitivity) Loose Bodies / Synovial Chondromatosis Impingement Mechanism Multiple Causes: Dislocation Synovial Chondromatosis OCD Catching pain Sharp Locking Femoroacetabular Impingement Labral Tear • Pain with repetitive twisting History and strenuous pivoting Sharp groin pain, • Impingement Sign Exacerbated with flexion – Pain when maximally flexed activities and internally rotated – Postero/supero labrum (87% Catching sensitivity) “C” Sign • McCarthy’s Sign Radiate to buttock or thigh – Pain with full extension of a History of intermittent flexed and externally rotated hip groin strain – Anterior labrum (82% sensitivity) 4 12/9/2013 Peritrochanteric/Buttock “Hip Open vs. Arthroscopic Treatment Pain” • Burnese experience Trochanteric Bursitis – Open dislocation with External Snapping Hip osteoplasty Gluteus Medius – Long term results show minimal change Tendinosis/ Tears in outcome Piriformis Pain • Arthroscopic – Minimally invasive – Takedown and repair possible Ruptured Ligamentum Teres Bursitis Occurs from Repetitive Friction with History of injury Nearby Muscle or Traumatic Injury to Pain with flexion and Surrounding Tissue internal rotation Can Be Difficult to Differentiate from MRI Arthrography other Soft Tissue Processes may show lesion in e.g. Contusion or Strain fossa Several (13) Bursa About Hip Four Major Bursa Trochanteric Bursa Ischial Bursa Iliopectineal Bursa Iliopsoas Bursa Tumor Pelvic/Hip Bursitis • Trochanteric Should always be – Friction of IT band over Gr. Troch. considered – Localized by ER and adduction Night pain, rest pain • Ischial Constitutional – Common in Hockey and Skaters – Exacerbated by Sitting symptoms • Illiopsoas Mets, Primary Tumor, – Anterior Snapping Hip PVNS • Illiopectineal – Continuance of Illiopsoas bursa – Irritation of Illiopsoas tendon over IP eminence 5 12/9/2013 Snapping Hip Syndrome Coxa Saltans Arthroscopic Bursectomy and External is most common Tendon Repair ITB or Gluteus Maximus Sliding Over Occur in Active Late For recalcitrant Bursitis Trochanter Teens and 20’s Lengthening of IT Inflammation of the Trochanteric band Bursa Debridement or Internal Repair of Abductors Iliopsoas Snaps over Iliopectineal Eminence or Femoral Head Intra‐articular Labral Tears, Loose Bodies, Osteochondral Injury Often History of Trauma Gluteus Medius Tear Other “Hip Pain •Late‐Middle age (F>M) •Tendinosis (similar to Rotator Cuff) •Possible cause of recalcitrant Bursitis Muscle Strains and Tendonitis Gluteus Medius Tear Cause Symptoms: Violent Eccentric Contraction Postero‐medial Pain with Muscle on Stretch Contused Muscle is Susceptible Sitting and transitional to Strain Injury pain May also develop from Activity related Microtrauma Exam Trendelenburg Sign Muscles that Cross 2 Joints Isolated Weakness are More Susceptible to Strain 45’ hip flexion Adductor Longus Rectus Femoris External Oblique 6 12/9/2013 Myositis Ossificans • Occurs In: Avulsion Fractures – Areas of Deep Soft Tissue Injury with Hematoma Skeletally immature athletes – Around a Joint or Tendon Insertion / Origin Failure at apophysis ASIS • Presents as Painful Mass AIIS Associated with Loss of Iliac Crest Motion Greater Trochanter Lesser Trochanter • Radiographs Lag Behind Ischial Tuberosity Larson, et al. Evaluating and Managing Muscle • Treatment is based on Contusions and Myositis Ossificans. Phys Sport Med. clinical findings Vol 30 / No 2: Feb, 2002. Apophysitis • Can Occur Anywhere in Hip Girdle Nerve Entrapment Syndromes – Iliac Crest Most Likely Sciatic Piriformis Syndrome • Overuse phenomenon – Similar to Other Apophysites Obturator Pudendal • Diagnosis by Clinical Exam – Tender to Palpation over Area Ilioinguinal Femoral • Radiographs Show Physeal Widening if Chronic Lateral Femoral Cutaneous Nerve McCrory & Bell. Nerve Entrapment Syndromes as a Cause of Pain in the Hip, Groin and Buttock. Sports Med 1999 Apr; 27 (4): 261- • Treat by Modifying Offending 274. Activities Until Discomfort Subsides Contusions Most Common Athletic Hip Treatment Overview Injury Physical Therapy Imaging Usually Collision with Another 1st Line Treatment Xray Player, Equipment Collision or Range of Motion MR Arthrogram Fall to Surface US/Deep Tissue CT (3‐D recon) release US –user dependant Can Occur Over Bony Graston Technique Cortisone Injection Prominences: Core/Hip Strength Diagnostic and Iliac Crest –“Hip Pointer” theraputic Greater Trochanter Ischial tuberosity 7 12/9/2013 Questions Surgical Treatment • A 25 Year Old Professional Hockey Player is Referred to Your Office by the Team Trainer After 6 Weeks of Physical After all else fails… Therapy Failed to Improve His Symptoms. X-Rays and MRI Open vs Arthroscopic of
Load more

Recommended publications
  • MUSCULOSKELETAL MRI Temporomandibular Joints (TMJ) Temporomandibular Joints (TMJ) MRI - W/O Contrast
    MUSCULOSKELETAL MRI Temporomandibular Joints (TMJ) Temporomandibular joints (TMJ) MRI - W/O Contrast . CPT Code 70336 • Arthritis • TMJ disc abnormality • Osteonecrosis (AVN) Temporomandibular joints (TMJ) MRI - W and W/O Contrast . CPT Code 70336 • Arthritis/Synovitis • Mass/Tumor Chest Chest Wall/Rib, Sternum, Bilateral Pectoralis Muscles, Bilateral Clavicles MRI - W/O Contrast . CPT Code 71550 • Rib fracture, costochondral cartilage injury • Muscle, tendon or nerve injury Chest Wall/Rib, Sternum, Bilateral Pectoralis Muscles, Bilateral Clavicles MRI - W and W/O Contrast . CPT Code 71552 • Mass/Tumor • Infection Upper Extremity (Non-Joint) Scapula MRI - W/O Contrast . CPT Code 73218 • Fracture • Muscle, tendon or nerve injury Scapula MRI - W and W/O Contrast . CPT code 73220 • Mass/Tumor • Infection Humerus, Arm MRI - W/O Contrast . CPT Code 73218 • Fracture • Muscle, tendon or nerve injury Humerus, Arm MRI - W and W/O Contrast . CPT Code 73220 • Mass/Tumor • Infection Forearm MRI - W/O Contrast . CPT Code 73218 • Fracture • Muscle, tendon or nerve injury Forearm MRI - W and W/O Contrast . CPT Code 73220 • Mass/Tumor • Infection Hand MRI - W/O Contrast. CPT Code 73218 • Fracture • Muscle, tendon or nerve injury Hand MRI - W and W/O Contrast . CPT Code 73220 • Mass/Tumor • Infection • Tenosynovitis Finger(s) MRI - W/O Contrast. CPT Code 73218 • Fracture • Muscle, tendon or nerve injury Finger(s) MRI - W and W/O Contrast . CPT Code 73220 • Mass/Tumor • Infection • Tenosynovitis Upper Extremity (Joint) Shoulder MRI - W/O Contrast. CPT Code 73221 • Muscle, tendon (rotator cuff) or nerve injury • Fracture • Osteoarthritis Shoulder MRI - W Contrast (Arthrogram only; no IV contrast) . CPT Code 73222 • Labral (SLAP) tear • Rotator cuff tear Shoulder MRI - W and W/O Contrast .
    [Show full text]
  • Femoral Nerve Dimensions at the Inguinal Ligament and Inguinal Crease Levels: Implications for Femoral Nerve Block
    Original article http://dx.doi.org/10.4322/jms.062413 Femoral nerve dimensions at the inguinal ligament and inguinal crease levels: implications for femoral nerve block OYEDUN, O. S.1*, RUKEWE, A.2 and FATIREGUN, A.3 1Gross Anatomy Lab, Department of Anatomy, Faculty of Basic Medical Sciences, University of Ibadan, +234 Ibadan, Oyo State, Nigéria 2Anaesthesia Unit, Accident and Emergency Department, University College Hospital, +234 Ibadan, Oyo State, Nigéria 3Department of Epidemiology and Medical Statistics, Faculty of Public Health, University of Ibadan, +234 Ibadan, Oyo State, Nigéria *E-mail: [email protected] Abstract Introduction: Femoral nerve block, when used solely or as a supplement to general anaesthesia, provides anaesthesia and analgesia to the anterior thigh. In spite of its established benefits, femoral nerve block is still underutilized in Nigeria. Our objective was to study the dimensions of femoral nerve at the level of the inguinal ligament and inguinal crease using a cadaveric model; no such data exists in Nigeria. Materials and Methods: Using 7 adult human cadavers (6 males and 1 female), the depth and thickness of the femoral nerve were measured at the levels of inguinal ligament and inguinal crease. The spatial relationship of femoral nerve to the surrounding structures was also observed. Result: The study showed a significantly wider thickness and shorter depth of the femoral nerve at the level of inguinal crease relative to inguinal ligament. Conclusion: We concluded that in centers where ultrasound and neurostimulation techniques for femoral nerve block in Nigerians are unavailable, the inguinal crease level where the femoral nerve is more superficial and wider in thickness would be the landmark of choice compared to the inguinal ligament level.
    [Show full text]
  • Sportsmans Groin: the Inguinal Ligament and the Lloyd Technique
    Rennie, WJ and Lloyd, DM. Sportsmans Groin: The Inguinal Ligament and the Lloyd Technique. Journal of the Belgian Society of Radiology. 2017; 101(S2): 16, pp. 1–4. DOI: https://doi.org/10.5334/jbr-btr.1404 OPINION ARTICLE Sportsmans Groin: The Inguinal Ligament and the Lloyd Technique WJ Rennie and DM Lloyd Groin pain is a catch all phrase used to define a common set of symptoms that affect many individuals. It is a common condition affecting sportsmen and women (1, 2) and is often referred to as the sportsman groin (SG). Multiple surgical operations have been developed to treat these symptoms yet no definitive imaging modalities exist to diagnose or predict prognosis. This article aims to discuss the anatomy of the groin, suggest a biomechanical pathophysiology and outline a logical surgical solution to treat the underlying pathology. A systematic clinical and imaging approach with inguinal ligament and pubic specific MRI assessment, can result in accurate selection for intervention. Close correlation with clinical examination and imaging in series is recommended to avoid misinterpretation of chronic changes in athletes. Keywords: Groin pain; Inguinal Ligament; MRI; Surgery; Lloyd release Introduction from SG is due to altered biomechanics, with specific pain Groin pain is a catch all phrase used to define a common symptoms that differ from those caused by inguinal or set of symptoms that affect many individuals. It is a com- femoral hernias. mon condition affecting sportsmen and women [1, 2] and is often referred to as the sportsman groin (SG). Multiple Anatomy of Sportsman’s Groin surgical operations have been developed to treat these The anatomical central structure in the groin is the pubic symptoms, yet no definitive imaging modalities exist to bone.
    [Show full text]
  • Describe the Anatomy of the Inguinal Canal. How May Direct and Indirect Hernias Be Differentiated Anatomically
    Describe the anatomy of the inguinal canal. How may direct and indirect hernias be differentiated anatomically. How may they present clinically? Essentially, the function of the inguinal canal is for the passage of the spermatic cord from the scrotum to the abdominal cavity. It would be unreasonable to have a single opening through the abdominal wall, as contents of the abdomen would prolapse through it each time the intraabdominal pressure was raised. To prevent this, the route for passage must be sufficiently tight. This is achieved by passing through the inguinal canal, whose features allow the passage without prolapse under normal conditions. The inguinal canal is approximately 4 cm long and is directed obliquely inferomedially through the inferior part of the anterolateral abdominal wall. The canal lies parallel and 2-4 cm superior to the medial half of the inguinal ligament. This ligament extends from the anterior superior iliac spine to the pubic tubercle. It is the lower free edge of the external oblique aponeurosis. The main occupant of the inguinal canal is the spermatic cord in males and the round ligament of the uterus in females. They are functionally and developmentally distinct structures that happen to occur in the same location. The canal also transmits the blood and lymphatic vessels and the ilioinguinal nerve (L1 collateral) from the lumbar plexus forming within psoas major muscle. The inguinal canal has openings at either end – the deep and superficial inguinal rings. The deep (internal) inguinal ring is the entrance to the inguinal canal. It is the site of an outpouching of the transversalis fascia.
    [Show full text]
  • A+ Mobile Ultrasound Services LLC Seattle, WA 206-799-3301 [email protected] Musculoskeletal (MSK)
    A+ Mobile Ultrasound Services LLC Seattle, WA 206-799-3301 [email protected] Musculoskeletal (MSK) www.APlusUltrasound.com Shoulder Hip • Rotator Cuff Tear/Tedonosis • Bowel Hernia • Biceps Tendon Tear • Sports Hernia • Tendinitis/Tenosynovitis/Subluxation • Snapping Hip Syndrome • Shoulder Impingement • Effusion • AC joint separation • Gluteal or thigh muscle injury • Fluid Collections – Bursitis / Effusion Knee Elbow • MCL / LCL Injury • Tennis Elbow – Lateral Epicondylitis • Iliotibial Band Syndrome • Golfer’s Elbow – Medial Epicondylitis • Jumper’s Knee – Patellar Tendon Injury • Biceps Tendon Insertion • Lateral, Medial or Posterior Meniscus Tear • Ulnar Nerve Entrapment • Runner’s knee • (Cubital Tunnel Syndrome) • Fluid collection – Bursitis / Effusion / Baker’s • Ulnar Collateral Ligament (UCL) Injury Cyst • Triceps Tendon Tear/Tendonosis Ankle/Foot • Fluid Collection – Bursitis / Effusion • Achilles’ Tendon Tear/Tendinitis Wrist • Tibial Tendon Tear/Tendinitis/Tenosynovitis • Medial Nerve Entrapment • Peroneal • Carpal Tunnel Syndrome Tear/Tendinitis/Tenosynovitis/Subluxation • Extensor Tendonosis/Tenosynovitis • Ankle Sprain – Ligament Injury (ATFL) • De Quervain’s Syndrome • High Ankle Sprain – Tibiofibular Ligament Tear • Flexor Tendonosis/Tenosynovitis • Tibial Nerve Entrapment Hand/Finger • Fluid Collection – Bursitis / Effusion • Trigger Finger • Plantar Fasciitis • Avulsion • Morton’s Neuroma • Fracture • Turf Toe MSK Jaw and Neck Ultrasound MSK Extremity – Non Joint • Neck Pain • Muscle Sprain/Tear • Whiplash
    [Show full text]
  • Clinical Pelvic Anatomy
    SECTION ONE • Fundamentals 1 Clinical pelvic anatomy Introduction 1 Anatomical points for obstetric analgesia 3 Obstetric anatomy 1 Gynaecological anatomy 5 The pelvic organs during pregnancy 1 Anatomy of the lower urinary tract 13 the necks of the femora tends to compress the pelvis Introduction from the sides, reducing the transverse diameters of this part of the pelvis (Fig. 1.1). At an intermediate level, opposite A thorough understanding of pelvic anatomy is essential for the third segment of the sacrum, the canal retains a circular clinical practice. Not only does it facilitate an understanding cross-section. With this picture in mind, the ‘average’ of the process of labour, it also allows an appreciation of diameters of the pelvis at brim, cavity, and outlet levels can the mechanisms of sexual function and reproduction, and be readily understood (Table 1.1). establishes a background to the understanding of gynae- The distortions from a circular cross-section, however, cological pathology. Congenital abnormalities are discussed are very modest. If, in circumstances of malnutrition or in Chapter 3. metabolic bone disease, the consolidation of bone is impaired, more gross distortion of the pelvic shape is liable to occur, and labour is likely to involve mechanical difficulty. Obstetric anatomy This is termed cephalopelvic disproportion. The changing cross-sectional shape of the true pelvis at different levels The bony pelvis – transverse oval at the brim and anteroposterior oval at the outlet – usually determines a fundamental feature of The girdle of bones formed by the sacrum and the two labour, i.e. that the ovoid fetal head enters the brim with its innominate bones has several important functions (Fig.
    [Show full text]
  • Eastern Athletic Trainers' Association Annual Meeting & Clinical Symposium Cd Subject Index
    EASTERN ATHLETIC TRAINERS’ ASSOCIATION ANNUAL MEETING & CLINICAL SYMPOSIUM CD SUBJECT INDEX 11/18/06 A ACI Questioning Skills (abstract)- 2006 ACL Injuries in Females-2004 ACL Surgery Workshop-2006 Acute Trauma With Recurrent Shoulder Instability (abstract)- 2006 Adherence To Rehabilitation- Research To Reality Presentation 2006 Alternatives to NSAIDS- 2006 An Infrapatellar Fat Pad Tear In A High School Athlete (abstract)- 2007 An Outcomes Analysis Of A Sports Medicine Approach To Prevent And Manage Work-Related Low Back Pain (abstract)- 2007 Anatomical and Biomechanical Assessments of Medial Tibial Stress Syndrome (abstract)- 2006 Anatomical Evaluation of Tibial Nerve (abstract)- 2006 Ankle Anatomy- 2004 Ankle- Chronic Dysfunction Test (abstract)- 2004 Ankle Injury- Return to Play Criteria- 2004 Ankle Research Update-2004 Ankle-Talar Dome Injury (abstract)- 2004 Anterior Cruciate Ligament Injury Of The Knee With Secondary Development Of A Deep Vein Thrombosis In An Intercollegiate Female Volleyball Player (abstract)- 2007 Aquatic Plyometric Training Program (abstract)- 2006 Aquatic Therapy- 2004 Asthma- 2004 Athletic Training Students’ Perception of Their Retention in Undergrad AT Programs (abstract)-04 Athletic Training Students’ Use Of Time During Clinical Education Experiences: A Case Study Approach Using Time Profiles (abstract) – 2005 Athletic Pubalgia And Adductor Tendon Avulsion Repair In A Collegiate Football Player (abstract)- 2007 Auscultation Skills- 2004 Automated External Defibrillators- 2004 Avulsion Fracture Of Lesser
    [Show full text]
  • Iliopectineal Ligament As an Important Landmark in Ilioinguinal Approach of the Anterior Acetabulum
    International Journal of Anatomy and Research, Int J Anat Res 2019, Vol 7(3.3):6976-82. ISSN 2321-4287 Original Research Article DOI: https://dx.doi.org/10.16965/ijar.2019.274 ILIOPECTINEAL LIGAMENT AS AN IMPORTANT LANDMARK IN ILIOINGUINAL APPROACH OF THE ANTERIOR ACETABULUM: A CADAVERIC MORPHOLOGIC STUDY Ayman Ahmed Khanfour *1, Ashraf Ahmed Khanfour 2. *1 Anatomy department Faculty of Medicine, Alexandria University, Egypt. 2 Chairman of Orthopaedic surgery department Damanhour National Medical Institute Egypt. ABSTRACT Background: The iliopectineal ligament is the most stout anterior part of the iliopectineal membrane. It separates “lacuna musculorum” laterally from “lacuna vasorum” medially. This ligament is an important guide in the safe anterior approach to the acetabulum. Aim of the work: To study the detailed anatomy of the iliopectineal ligament demonstrating its importance as a surgical landmark in the anterior approach to the acetabulum. Material and methods: The material of this work included eight adult formalin preserved cadavers. Dissection of the groin was done for each cadaver in supine position with exposure of the inguinal ligament. The iliopectineal ligament and the three surgical windows in the anterior approach to the acetabulum were revealed. Results: Results described the detailed morphological anatomy of the iliopectineal ligament as regard its thickness, attachments and variations in its thickness. The study also revealed important anatomical measurements in relation to the inguinal ligament. The distance between the anterior superior iliac spine (ASIS) to the pubic tubercle ranged from 6.7 to 10.1 cm with a mean value of 8.31±1.3. The distance between the anterior superior iliac spine (ASIS) to the blending point of the iliopectineal ligament to the inguinal ligament ranged from 1.55 to 1.92 cm with a mean value of 1.78±0.15.
    [Show full text]
  • Henle's Ligament: a Comprehensive Review of Its Anatomy and Terminology Over Almost One and a Half Centuries
    Providence St. Joseph Health Providence St. Joseph Health Digital Commons Journal Articles and Abstracts 9-26-2018 Henle's Ligament: A Comprehensive Review of Its Anatomy and Terminology over Almost One and a Half Centuries. Raja Gnanadev Joe Iwanaga Rod J Oskouian Neurosurgery, Swedish Neuroscience Institute, Seattle, USA. Marios Loukas R Shane Tubbs Follow this and additional works at: https://digitalcommons.psjhealth.org/publications Part of the Medical Pathology Commons, and the Neurosciences Commons Recommended Citation Gnanadev, Raja; Iwanaga, Joe; Oskouian, Rod J; Loukas, Marios; and Tubbs, R Shane, "Henle's Ligament: A Comprehensive Review of Its Anatomy and Terminology over Almost One and a Half Centuries." (2018). Journal Articles and Abstracts. 996. https://digitalcommons.psjhealth.org/publications/996 This Article is brought to you for free and open access by Providence St. Joseph Health Digital Commons. It has been accepted for inclusion in Journal Articles and Abstracts by an authorized administrator of Providence St. Joseph Health Digital Commons. For more information, please contact [email protected]. Open Access Review Article DOI: 10.7759/cureus.3366 Henle’s Ligament: A Comprehensive Review of Its Anatomy and Terminology over Almost One and a Half Centuries Raja Gnanadev 1 , Joe Iwanaga 2 , Rod J. Oskouian 3 , Marios Loukas 4 , R. Shane Tubbs 5 1. Research Fellow, Seattle Science Foundation, Seattle, USA 2. Medical Education and Simulation, Seattle Science Foundation, Seattle, USA 3. Neurosurgery, Swedish Neuroscience Institute, Seattle, USA 4. Anatomical Sciences, St. George's University, St. George's, GRD 5. Neurosurgery, Seattle Science Foundation, Seattle, USA Corresponding author: Joe Iwanaga, [email protected] Disclosures can be found in Additional Information at the end of the article Abstract Henle’s ligament was first described by German physician and anatomist, Friedrich Henle, in 1871.
    [Show full text]
  • Preventing Athletic Pubalgia and Chronic Groin Pain in the Soccer Player Layout 1
    ERFORMANCE P SOCCER CONDITIONING A NEWSLETTER DEDICATED TO IMPROVING SOCCER PLAYERS www.performancecondition.com/soccer Preventing Athletic Pubalgia and Chronic Groin Pain in the Soccer Player Chet North The Many Causes of Groin Pain There can be pain in the hip area because of the many different structures there. You have glands that fight off infection plus muscles and tendons located in your upper thighs under the crease of your thigh and abdomen. There is a lot going on in this area. Adding to the situation in highly competitive soccer, even the articulating surface of the hips can cause some pain. With all this it's really hard to differentiate what the pain might be. Is it an articulating surface? Tendonitis? Rupture of a muscle or tendon? Or is it a situation where a tendon separated from part of a bone? There are many causes of pain in this very mobile area. As a coach, to call it pubalgia in the training room or on the soccer field is hard to do. It might be a strain or tendonitis of an adductor, which pulls the hip in. It might be a hip flexor, which brings the hip forward. It might be a pubalgia-type injury where you have strain of the abdominal wall and structures of the lower abdominal area; however, it's hard to determine. It's vague, and that's why you want to have a doctor look at these symptoms early on. A lot of the injuries we think are just muscle strains can be much more than that.
    [Show full text]
  • Diagnosis and Management of Snapping Hip Syndrome
    Cur gy: ren lo t o R t e a s e m a u r c e h h Via et al., Rheumatology (Sunnyvale) 2017, 7:4 R Rheumatology: Current Research DOI: 10.4172/2161-1149.1000228 ISSN: 2161-1149 Review article Open Access Diagnosis and Management of Snapping Hip Syndrome: A Comprehensive Review of Literature Alessio Giai Via1*, Alberto Fioruzzi2, Filippo Randelli1 1Department of Orthopaedics and Traumatology, Hip Surgery Center, IRCCS Policlinico San Donato, Milano, Italy 2Department of Orthopaedics and Traumatology, IRCCS Policlinico San Matteo, Pavia, Italy *Corresponding author: Alessio Giai Via, Department of Orthopaedics and Traumatology, Hip Surgery Center, IRCCS Policlinico San Donato, Milano, Italy, Tel: +393396298768; E-mail: [email protected] Received date: September 11, 2017; Accepted date: November 21, 2017; Published date: November 30, 2017 Copyright: ©2017 Via AG, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Background: Snapping hip is a common clinical condition, characterized by an audible or palpable snap of the hip joint. The snap can be perceived at the lateral side of the hip (external snapping hip), or at the medial (internal snapping hip). It is usually asymptomatic, but in few cases, in particular in athletes, the snap become painful (snapping hip syndrome-SHS). Materials and methods: This is a narrative review of current literature, which describes the pathogenesis, diagnosis and treatment of SHS. Conclusion: The pathogenesis of SHS is multifactorial.
    [Show full text]
  • Laparoscopic Inguinal Ligament Suspension: a Novel Procedure to Repair Uterine Prolapse
    International Urogynecology Journal (2019) 30:657–660 https://doi.org/10.1007/s00192-018-3780-6 IUJ VIDEO Laparoscopic inguinal ligament suspension: a novel procedure to repair uterine prolapse Zhiyuan Dai1 & Hui Li1 & Huimin Shu1 & Xiaohong Guan 1 & Kai Zhang2 Received: 25 December 2017 /Accepted: 24 September 2018 /Published online: 25 October 2018 # The International Urogynecological Association 2018 Abstract Introduction and hypothesis Traditionally, surgical treatment for uterine prolapse has included hysterectomy. However, more patients now prefer a uterine-preserving operation because of concerns about fertility or sexual dysfunction. In this video, we describe a novel approach to correcting uterine prolapse in an attempt to demonstrate an alternative option for patients. Methods A 42-year-old woman with symptomatic stage I-IV uterine prolapse (POP-Q: Aa +2, Ba +2, C + 3, gh 6.5, pb 3, TVL 8.5, Ap 0, Bp 0, D 0) underwent inguinal ligament suspension. The principle steps and techniques to complete the operation are outlined in the video. Results Prolapse repair was successfully completed without any intraoperative complications. The uterus was restored to its anatomic position. During the 12-month follow-up, neither recurrence nor postoperative complications, such as mesh exposure, de novo incontinence or bowel obstruction, etc., occurred. Conclusions Laparoscopic inguinal ligament suspension is a safe and feasible alternative for correcting the uterine prolapse. This surgery could be an attractive choice for patients who prefer a uterine-sparing surgery. Keywords Inguinal ligament suspension . Laparoscopic route . Pelvic organ prolapse . Uterine prolapse . Uterine-sparing surgery Aim of the video Methods Here we demonstrate the principle steps of laparoscopic in- The featured patient in the video is a 42-year-old multiparous guinal ligament suspension, a novel uterine-preserving proce- woman with 3 years of symptomatic apical prolapse.
    [Show full text]