Femoral Injecting Guide
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Corporate Medical Policy Surgery for Groin Pain in Athletes
Corporate Medical Policy Surgery for Groin Pain in Athletes File Name: surgery_for_groin_pain_in_athletes Origination: 8/2014 Last CAP Review: 6/2020 Next CAP Review: 6/2021 Last Review: 6/2020 Description of Procedure or Service Sports-related groin pain, commonly known as athletic pubalgia or sports hernia, is characterized by disabling activity-dependent lower abdominal and groin pain that is not attributable to any other cause. Athletic pubalgia is most frequently diagnosed in high-performance male athletes, particularly those who participate in sports that involve rapid twisting and turning such as soccer, hockey, and football. Alternative names include Gilmore’s groin, osteitis pubis, pubic inguinal pain syndrome, inguinal disruption, slap shot gut, sportsmen’s groin, footballers groin injury complex, hockey groin syndrome, athletic hernia, sports hernia and core muscle injury. For patients who fail conservative therapy, surgical repair of any defects identified in the muscles, tendons or nerves has been proposed. Groin pain in athletes is a poorly defined condition, for which there is not a consensus regarding the cause and/or treatment. Some believe the groin pain is an occult hernia process, a prehernia condition, or an incipient hernia, with the major abnormality being a defect in the transversalis fascia, which forms the posterior wall of the inguinal canal. Another theory is that injury to soft tissues that attach to or cross the pubic symphysis is the primary abnormality. The most common of these injuries is thought to be at the insertion of the rectus abdominis onto the pubis, with either primary or secondary pain arising from the adductor insertion sites onto the pubis. -
Lower Extremity Deep Venous Thrombosis
SECTION 5 Vascular System CHAPTER 34 Lower Extremity Deep Venous Thrombosis Ariel L. Shiloh KEY POINTS • Providers can accurately detect lower extremity deep venous thrombosis with point-of- care ultrasound after limited training. • Compression ultrasound exams are as accurate as traditional duplex and triplex vascular ultrasound exams. • Compression ultrasound exam at only two sites, the common femoral vein and popliteal vein, permits rapid and accurate assessment of deep venous thrombosis. Background care providers can perform lower extremity compression ultrasonography exams rapidly Venous thromboembolic disease (VTE) is a and with high diagnostic accuracy to detect common cause of morbidity and mortality in DVT. 7–13 A meta-analysis of 16 studies showed hospitalized patients and is especially preva- that point-of-care ultrasound can accurately lent in critically ill patients.1–3 Approximately diagnose lower extremity DVTs with a pooled 70% to 90% of patients with an identified source sensitivity of 96% and specificity of 97%.14 of pulmonary embolism (PE) have a proxi- Traditional vascular studies, the duplex mal lower extremity deep venous thrombosis and triplex exams, use a combination of (DVT). Conversely, 40% to 50% of patients two-dimensional (2D) imaging with compres- with a proximal DVT have a concurrent pul- sion along with the use of color and/or spectral monary embolism at presentation, and simi- Doppler ultrasound. More recent studies have larly, in only 50% of patients presenting with a demonstrated that 2D compression ultrasound PE can a DVT be found.4–6 exams alone yield similar accuracy as tradi- Point-of-care ultrasound is readily available tional duplex or triplex vascular studies.9,11,15–17 as a diagnostic tool for VTE. -
Isolated Deep Venous Thrombosis: Implications for 2-Point Compression Ultrasonography of the Lower Extremity
IMAGING/ORIGINAL RESEARCH Isolated Deep Venous Thrombosis: Implications for 2-Point Compression Ultrasonography of the Lower Extremity Srikar Adhikari, MD, MS*; Wes Zeger, DO; Christopher Thom, MD; J. Matthew Fields, MD *Corresponding Author. E-mail: [email protected]. Study objective: Two-point compression ultrasonography focuses on the evaluation of common femoral and popliteal veins for complete compressibility. The presence of isolated thrombi in proximal veins other than the common femoral and popliteal veins should prompt modification of 2-point compression technique. The objective of this study is to determine the prevalence and distribution of deep venous thrombi isolated to lower-extremity veins other than the common femoral and popliteal veins in emergency department (ED) patients with clinically suspected deep venous thrombosis. Methods: This was a retrospective study of all adult ED patients who received a lower-extremity venous duplex ultrasonographic examination for evaluation of deep venous thrombosis during a 6-year period. The ultrasonographic protocol included B-mode, color-flow, and spectral Doppler scanning of the common femoral, femoral, deep femoral, popliteal, and calf veins. Results: Deep venous thrombosis was detected in 362 of 2,451 patients (14.7%; 95% confidence interval [CI] 13.3% to 16.1%). Thrombus confined to the common femoral vein alone was found in 5 of 362 cases (1.4%; 95% CI 0.2% to 2.6%). Isolated femoral vein thrombus was identified in 20 of 362 patients (5.5%; 95% CI 3.2% to 7.9%). Isolated deep femoral vein thrombus was found in 3 of 362 cases (0.8%; 95% CI –0.1% to 1.8%). -
Groin and Buttock Claudication Associated with Vascular Origin Due to Chronic Occlusion of Internal Iliac Artery -A Case Report
Anesth Pain Med 2015; 10: 93-96 http://dx.doi.org/10.17085/apm.2015.10.2.93 ■Case Report■ Groin and buttock claudication associated with vascular origin due to chronic occlusion of internal iliac artery -A case report- Departments of Anesthesiology and Pain Medicine, *Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of † Medicine, Seoul, Ire Pain Clinic, Incheon, Korea Hyun Mo Chung, Sang-Soo Kang, Keun-Man Shin, Sang-hoon Lee, Sung Eun Kim*, and Hong-Seong Yoo† Neurogenic and vascular claudication is sometimes difficult to When concomitant symptoms such as radiating pain are distinguish from each other due to similarities in symptoms. present, a herniated disc could be considered first [3]. We Symptoms and physical examinations may not always match the report a rare case of severe groin pain of vascular origin, severity in both diseases, and when atypical symptoms, such as groin pain, are present, diagnosis can be more challenging. Proper associated with mild pain in the buttock and lower leg, differential diagnosis of the two is important because of the without the typical vascular symptoms due to well developed invasiveness of treatment in both diseases. We report a rare case collateral flow of abdominal wall vessels. of a patient with severe groin and buttock pain due to chronic occlusion of the internal iliac artery, along with a review of the relevant literature. (Anesth Pain Med 2015; 10: 93-96) CASE REPORT Key Words: Claudication, Groin, Internal iliac artery, Pain. A 70-year-old male with persistent bilateral groin pain, more severe on the left, visited our department of pain medicine. -
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. -
Sir Ganga Ram Hospital Classification of Groin and Ventral Abdominal Wall Hernias
Symposium Sir Ganga Ram Hospital classification of groin and ventral abdominal wall hernias Pradeep K Chowbey, Rajesh Khullar, Magan Mehrotra, Anil Sharma, Vandana Soni, Manish Baijal Minimal Access and Bariatric Surgery Centre, Sir Ganga Ram Hospital, New Delhi - 110 060, India Address for correspondence: Pradeep K. Chowbey, Minimal Access and Bariatric Surgery Centre, Room No. 200 (2nd floor), Sir Ganga Ram Hospital, New Delhi - 110 060, India. E-mail: [email protected] Abstract of all ventral hernias of the abdomen. The system proposed by us includes all abdominal wall hernias and Background: Numerous classifications for groin is a final classification that predicts the expected level and ventral hernias have been proposed over the of difficulty for an endoscopic hernia repair. past five to six decades. The old, simple classification of groin hernia in to direct, inguinal Key words: Total extraperitoneal repair, SGRH classification, and femoral components is no longer adequate to laparoscopic ventral hernia repair understand the complex pathophysiology and management of these hernias.The most commonly followed classification for ventral hernias divide CLASSIFICATION SYSTEMS FOR GROIN HERNIA them into congenital, acquired, incisional and traumatic, which also does not convey any Numerous classifications for groin hernia have been information regarding the predicted level of difficulty. proposed over the past five to six decades. The old Aim: All the previous classification systems were based on open hernia repairs and have their own simple classification of groin hernia into indirect and fallacies particularly for uncommon hernias that direct, inguinal and femoral components is no longer cannot be classified in these systems. With the adequate to understand the complex advent of laparoscopic/ endoscopic approach, pathophysiology and management of these hernias.[1] surgical access to the hernia as well as the In the 1950s and 1960s, many surgical classifications functional anatomy viewed by the surgeon changed. -
Lower Limb Venous Drainage
Vascular Anatomy of Lower Limb Dr. Gitanjali Khorwal Arteries of Lower Limb Medial and Lateral malleolar arteries Lower Limb Venous Drainage Superficial veins : Great Saphenous Vein and Short Saphenous Vein Deep veins: Tibial, Peroneal, Popliteal, Femoral veins Perforators: Blood flow deep veins in the sole superficial veins in the dorsum But In leg and thigh from superficial to deep veins. Factors helping venous return • Negative intra-thoracic pressure. • Transmitted pulsations from adjacent arteries. • Valves maintain uni-directional flow. • Valves in perforating veins prevent reflux into low pressure superficial veins. • Calf Pump—Peripheral Heart. • Vis-a –tergo produced by contraction of heart. • Suction action of diaphragm during inspiration. Dorsal venous arch of Foot • It lies in the subcutaneous tissue over the heads of metatarsals with convexity directed distally. • It is formed by union of 4 dorsal metatarsal veins. Each dorsal metatarsal vein recieves blood in the clefts from • dorsal digital veins. • and proximal and distal perforating veins conveying blood from plantar surface of sole. Great saphenous Vein Begins from the medial side of dorsal venous arch. Supplemented by medial marginal vein Ascends 2.5 cm anterior to medial malleolus. Passes posterior to medial border of patella. Ascends along medial thigh. Penetrates deep fascia of femoral triangle: Pierces the Cribriform fascia. Saphenous opening. Drains into femoral vein. superficial epigastric v. superficial circumflex iliac v. superficial ext. pudendal v. posteromedial vein anterolateral vein GREAT SAPHENOUS VEIN anterior leg vein posterior arch vein dorsal venous arch medial marginal vein Thoraco-epigastric vein Deep external pudendal v. Tributaries of Great Saphenous vein Tributaries of Great Saphenous vein saphenous opening superficial epigastric superficial circumflex iliac superficial external pudendal posteromedial vein anterolateral vein adductor c. -
DEPARTMENT of ANATOMY IGMC SHIMLA Competency Based Under
DEPARTMENT OF ANATOMY IGMC SHIMLA Competency Based Under Graduate Curriculum - 2019 Number COMPETENCY Objective The student should be able to At the end of the session student should know AN1.1 Demonstrate normal anatomical position, various a) Define and demonstrate various positions and planes planes, relation, comparison, laterality & b) Anatomical terms used for lower trunk, limbs, joint movement in our body movements, bony features, blood vessels, nerves, fascia, muscles and clinical anatomy AN1.2 Describe composition of bone and bone marrow a) Various classifications of bones b) Structure of bone AN2.1 Describe parts, blood and nerve supply of a long bone a) Parts of young bone b) Types of epiphysis c) Blood supply of bone d) Nerve supply of bone AN2.2 Enumerate laws of ossification a) Development and ossification of bones with laws of ossification b) Medico legal and anthropological aspects of bones AN2.3 Enumerate special features of a sesamoid bone a) Enumerate various sesamoid bones with their features and functions AN2.4 Describe various types of cartilage with its structure & a) Differences between bones and cartilage distribution in body b) Characteristics features of cartilage c) Types of cartilage and their distribution in body AN2.5 Describe various joints with subtypes and examples a) Various classification of joints b) Features and different types of fibrous joints with examples c) Features of primary and secondary cartilaginous joints d) Different types of synovial joints e) Structure and function of typical synovial -
Vessels in Femoral Triangle in a Rare Relationship Bandyopadhyay M, Biswas S, Roy R
Case Report Singapore Med J 2010; 51(1) : e3 Vessels in femoral triangle in a rare relationship Bandyopadhyay M, Biswas S, Roy R ABSTRACT vein, the longest superficial vein in the body, ends in the The femoral region of the thigh is utilised for femoral vein, which is a short distance away from the various clinical procedures, both open and inguinal ligament after passing through the saphenous closed, particularly in respect to arterial and opening.(2) venous cannulations. A rare vascular pattern was observed during the dissection of the femoral CASE REPORT region on both sides of the intact formaldehyde- A routine dissection in undergraduate teaching of an preserved cadaver of a 42-year-old Indian intact formaldehyde-preserved cadaver of a 42-year-old man from West Bengal. The relationships and Indian man from West Bengal revealed a rare pattern patterns found were contrary to the belief that of relationship between the femoral vessels on both the femoral vein is always medial to the artery, sides. The femoral artery crossed the femoral vein deep just below the inguinal ligament and the common to the inguinal ligament, such that the artery was lying femoral artery. The femoral artery crossed the superficial to the vein at the base of the femoral triangle. vein just deep to the inguinal ligament so that The profunda femoris artery was seen lying lateral, and the femoral vein was lying deep to the artery at the great saphenous vein medial, to the femoral vessels the base of the femoral triangle. Just deep to the in the triangle. -
Current Overview of Neurovascular Structures in Hip Arthroplasty
1mon.qxd 2/2/04 10:26 AM Page 73 REVIEW Current Overview of Neurovascular Structures in Hip Arthroplasty: Anatomy, Preoperative Evaluation, Approaches, and Operative Techniques to Avoid Complications John-Paul H. Rue, MD* Nozomu Inoue, MD, PhD* Michael A. Mont, MD† A major neurovascular injury during total hip arthroplasty (THA) is uncom- Educational Objectives mon. Nevertheless, these are worri- some due to their devastating conse- As a result of reading this article, physicians should be able to: quences. As more THAs are performed 1. Identify the bony, vascular, and neural anatomy that is relevant to the each year, the chances of this potential- surgeon performing total hip arthroplasty. ly life- or limb-threatening injury 2. Describe the common approaches to avoid neurovascular complica- increase.1 It is crucial for the orthope- tions. dic surgeon to have a thorough under- 3. Discuss the appropriate clinical work-up of these patients. standing of the anatomy of the region 4. Describe the various neurovascular complications and how to handle and the potential complications. them. This article reviews the exposures to the acetabulum for simple and complex primary THA, as well as revision cases, with particular attention to the neu- ischium, and pubis (Figure 1). The Damage to any of these vessels by rovascular anatomy of the region. acetabulum is located at the junction of retraction, drilling, reaming, or dissec- these three bones. These bones unite tion can cause massive hemorrhage, ANATOMY anteriorly at the pubic symphysis and which can lead to exsanguination with- Bone posteriorly to the sacrum to form a ring in minutes. -
Groin Injuries in Athletes
Groin Injuries in Athletes VINCENT MORELLI, M.D., Louisiana State University School of Medicine, New Orleans, Louisiana VICTORIA SMITH, M.D., Louisiana State University Health Sciences Center, Kenner, Louisiana Groin injuries comprise 2 to 5 percent of all sports injuries. Early diagnosis and proper treatment are important to prevent these injuries from becoming chronic and poten- tially career-limiting. Adductor strains and osteitis pubis are the most common muscu- loskeletal causes of groin pain in athletes. These two conditions are often difficult to distinguish. Other etiologies of groin pain include sports hernia, groin disruption, ilio- psoas bursitis, stress fractures, avulsion fractures, nerve compression and snapping hip syndrome. (Am Fam Physician 2001;64:1405-14.) he diagnosis of groin pain in unclear in approximately 30 percent of cases.4 athletes is difficult because the Factors that complicate the diagnosis include anatomy of the region is com- the complex anatomy of the region and the plex and because two or more frequent coexistence of two or more disor- injuries often coexist. Intra- ders. In one study5 of 21 patients with groin Tabdominal pathology, genitourinary abnor- pain, 19 patients were found to have two or malities, referred lumbosacral pain and hip more disorders. The investigators concluded joint disorders (e.g., arthritis, synovitis, avas- that groin pain in athletes is complex and can cular necrosis) must first be excluded. Once be difficult to evaluate even by experienced these conditions are ruled out, other muscu- physicians. loskeletal conditions involving the groin may The ability to visualize the anatomy of the be pursued (Table 1). groin area is important for both the physical Between 2 and 5 percent of all sports examination and the differential diagnosis. -
Atrial Fibrillation Ablation
Atrial Fibrillation Ablation Atrial Fibrillation Ablation This handout will help you learn about atrial fibrillation ablation, also called pulmonary vein isolation. © Hamilton Health Sciences, 2008 PD 6062 – 02/2012 dpc/pted/LrgBk/AtrialFibrillationAblation-trh.doc dt/February 27, 2012 2 15 Atrial Fibrillation Ablation Atrial Fibrillation Ablation How does the heart work? Notes: To understand atrial fibrillation, you need to know how the heart’s electrical system works. __________________________________________________________ The sinoatrial node (SA node) is a natural pacemaker. It starts the __________________________________________________________ electrical signal that travels across the upper 2 chambers or atria of the heart to the atrioventricular node (AV node). __________________________________________________________ The AV node transfers the electrical signal from the upper part of the heart to the lower 2 pumping chambers or ventricles. The bundle branches are __________________________________________________________ specialized tissue that help send electrical impulses through the ventricles. This makes a normal heart beat, called normal sinus rhythm. __________________________________________________________ __________________________________________________________ __________________________________________________________ SA node __________________________________________________________ Bundle branches __________________________________________________________ AV node __________________________________________________________