DOCSLIB.ORG

The Impact of Lower Extremity Function and Podiatric Interventions

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Impact of Lower Extremity Function and Podiatric Interventions SPORTS REHABILITATION GROIN PAIN: A VIEW FROM BELOW THE IMPACT OF LOWER EXTREMITY FUNCTION AND PODIATRIC INTERVENTIONS – Written by Michael Kinchington, Australia INTRODUCTION pain in sport, there is a lack of evidence- The objective of this paper is to: The evaluation and treatment of groin based medicine regarding diagnosis and 1. Review causes of groin pain in the pain in athletes is challenging, often conservative management of groin pain. athlete. because the anatomy is complex, multiple This is surprising as the morbidity of groin 2. Examine potential biomechanical risk pathologies coexist that can cause similar pain ranks only behind knee, anterior factors for groin pain. symptoms and the causation of injury cruciate ligament injury and bone fracture 3. Explore the role of podiatry in the is multi-factorial. Athletic groin injuries in terms of time loss from sport1. Much management of the athletic groin pain. are more prevalent in sports that involve of the scientific literature relies upon an kicking and twisting movements while association between qualitative history running. Sports such as ice hockey, fencing, taking, clinical appraisal and diagnostic handball, cross-country skiing, hurdling, imaging. Hence, links between groin pain high jumping and football (soccer and and lower extremity biomechanics are Asymmetry Australian Rules) commonly have a high poorly represented within the scientific incidence of groin injury. Groin pain literature. Despite the lack of an evidence of the legs is accounts for approximately 5 to 18% of base, clinically the link between foot-ankle all athletic injuries, with kicking sports biomechanics, leg length inequality and considered a risk generally producing most of these injuries. pelvic instability is clear. Within the clinical For example, the literature indicates that realm of sports injury, biomechanical factor for injury nearly 1/3 of soccer players will develop optimisation principals are frequently groin pain during the course of their careers. utilised to prevent, rehabilitate and manage Yet, despite the high prevalence of groin groin pain. 360 Sportsman’s Figure 1: Anatomy of athletic hernia pubalgia or ‘groin disruption injury’. kicking, changing directions and tenderness of the pubic symphysis exacerbated by provocative examination techniques. Sports hernia Obturator nerve Sports hernia is a medially-located bulge entrapment in the posterior wall of the inguinal canal due to weakening of the abdominal wall3. This has been attributed to an injury of the conjoint tendon (common insertion of internal oblique and transverse abdominus muscles joining the distal lateral edge of rectus abdominus). The conjoint tendon with the lower edge of internal oblique and Adductor tendinopathy transverse abdominus muscles protects the posterior wall of the inguinal canal (fascia transversalis), a weak point in the abdominal Osteitis pubis wall. The pathology is explained as interplay of opposing forces between the abdominal and adductor muscles. Conjoint tendon CAUSES OF GROIN PAIN IN THE ATHLETE avulsion fractures can also occur at the is the inferomedial portion of internal Groin pain reviewed attachment of the adductor tendons to oblique (trunk rotation and lateral flexion) The definition of groin pain is broad and the pubic bone, as well as repetitive micro- and transversal abdominus (core stability) vague. The literature provides no consensus trauma or shearing forces to the pubic muscles. The role of adductors is adduction, on pathology/pathophysiology or manage- symphysis. This micro-trauma exceeds the flexion and internal rotation of the hip. The ment. Groin pain involves a number of dynamic tissue capacity for hypertrophic condition presents often, and has complex conditions involving the lower abdomen, remodelling, resulting in tissue degenera- clinical findings and historically varying inguinal regions, proximal adductors and tion. The condition is overuse in nature, terminology. It is interchangeably referred perineum, upper anterior thigh and hip. caused by repetitive contraction of the to as a sportsman’s hernia, pre-hernia The most commonly seen groin pathology muscles that attach to the pubic bone complex, conjoint tendon tear, Gilmore’s is related to the adductor muscles, pubic and the pubic symphysis. Actions such groin, external oblique tear and inguinal symphysis, inguinal region and nerve as running, jumping, kicking and rapid wall deficiency4,5. Athletes who participate supply to the groin. changes of direction cause the abdominal in sports that require repetitive twisting Diagnosis is complicated by multiple and groin muscles to produce a pulling and turning at speed (Australian Rules groin pathologies presenting at one time. or traction force on the pubic bone. This football, soccer, hockey) are at most risk of This is referred to as ‘athletic pubalgia’, a adds to the suboptimal biomechanics of developing a ‘sports hernia’. generalised term that refers to a spectrum the pelvis and lower extremity, and results The mechanism is usually of insidious of musculoskeletal injuries that occur in and in excessive stress and injury. Despite the onset and often unilateral on the dominant around the pubic symphysis and that share clarity of the mechanism of injury, the kicking leg in football. However, it is similar mechanisms of injury and common condition is still not well-understood as it important to note that 1/3 of patients clinical manifestations2. Another clinically can involve multiple factors including: describe a sudden tearing sensation. The relevant label is ‘groin disruption injury’ • stress reaction of the pubic symphysis pain is typically localised to the conjoint (Figure 1) consisting of sportsman hernia, due to high shear forces common with tendon but may involve the inguinal osteitis pubis, conjoint tendinopathy, cutting and side-stepping actions, canal laterally or the lower abdomen. The adductor tendinopathy and obturator nerve • conjoint tendon or in combination pain increases with sudden movements, entrapment3. with the adductors that spreads to the acceleration, twisting, turning and kicking subchondral bone, and may be provoked by coughing and Osteitis pubis • an imbalance or loss of synergy between sneezing. Symptoms may range from mild Osteitis pubis is a condition that involves the abdominals and adductor muscles. tenderness without palpable protrusion of the pubic bone symphysis, surrounding Clinical signs of osteitis pubis include the inguinal wall, to severe tenderness but muscle insertions and structures. Small groin pain while climbing stairs, running, not a palpable protusion (hernia). 361 SPORTS REHABILITATION Musculotendinous Pubic region: adductor tendinopathy Figure 2: The inter-relationship of groin pain or ‘groin disruption injury’. Nerve entrapment Bone Groin disruption injury Obturator nerve/ Pubic: osteitis pubis (athletic pubalgia) ilioinguinal nerve Inguinal canal pathology Sports hernia: conjoint tendinopathy Adductor tendinopathy and strain cause nerve entrapment. Obturator entrap- Human movement patterns affect the way The most common musculoskeletal ment pain can present as a deep ache in the the body functions and are implicated in cause of groin pain is a muscle strain of proximal adductor region that is referred to sporting injury. The goal of sports medicine which the adductor longus muscle is the the medial thigh and worsens with exercise. is to maintain a state of equilibrium or most frequently injured. With repetitive Pain or numbness radiates down the inner homeostasis of the joints, muscles and loading this results in micro-inflammatory thigh, with associated weakness. The sporting techniques (e.g. walking, running, change in the para-symphseal bone which is obturator nerve arises from the ventral rami jumping and kicking) in an effort to prevent a precursor to osteitis pubis2. The adductors of L2 - L4 and descends through the psoas injury. Groin pain is a multifactorial dilemma act as primary stabilisers of the hip joint. muscle. The nerve continues to descend for the sports medicine practitioner. Adductor-related groin pain can be acute, through the obturator tunnel where it primarily as a strain of the myotendinous divides into an anterior and a posterior In the literature junction associated with a powerful branch. Pain typically has an insidious While an association exists between contraction (kicking actions) or can be onset and is localised to the adductor origin groin pain and sports involving kicking and chronic with tenderness over the adductor at the pubic bone. Imaging does not play a twisting activities when running, there is insertion at the pubic bone. Tendinopathy significant role in confirming the diagnosis, a lack of literature that investigates the in the groin is not acute, but a silent but may be important in excluding other effect of musculoskeletal biomechanics pathology. It presents with gradual pain diagnoses. Diagnostic measures include: in groin pain. This is most likely due to and stiffness in the groin region with start- • reproduction of pain by stretching the the anatomical and biomechanical causes up activity, dysfunction is exacerbated by adductor muscles after exercise, which are complex and controversial. To sprinting, cutting, kicking and sliding tackle • electromyography and highlight the lack of established scientific actions. Clinical signs include tenderness on • a local anaesthetic block of the obturator research in the groin-lower extremity palpation at the origin of the
Load more

Recommended publications
  • 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.
    [Show full text]
  • Use of Inflated Foley Catheters to Prevent Early Empty Pelvis Complications Following Pelvic Exenteration
    ANTICANCER RESEARCH 35: 5543-5546 (2015) Use of Inflated Foley Catheters to Prevent Early Empty Pelvis Complications Following Pelvic Exenteration NICOLAE BACALBASA1, DANA TOMESCU2 and IRINA BALESCU3 1Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 2Fundeni Clinical Institute, Department of Anaethesia and Critical Care III, Bucharest, Romania; 3Ponderas Hospital, Bucharest, Romania Abstract. For most patients with bulky pelvic tumors, neoadjuvant chemo-irradiation is performed in order to pelvic exenteration remains the only curative option. diminish the local invasion and to transform the patient into Although initially reported as a palliative procedure, a candidate for a less extended resection. However, there nowadays it is rather performed with curative intent. Once are cases in which local invasion persists after neoadjuvant the resectional phase is ended, a large defect will remain at treatment and in which pelvic exenteration is needed. Since the level of the pelvic diaphragm, predisposing to severe Brunschwig reported it for the first time in 1948, this complications which are generically included under the surgical procedure has become the golden-standard for name of empty pelvis syndrome. It has been widely patients with locally invasive pelvic malignancies (3). demonstrated that this type of complication is associated Although the resectional phase has remained practically with severe mortality, even if the patient is free of any pelvic unchanged, the reconstructive phase has undergone multiple recurrence. We present the case of a 56-year-old patient improvements in order to improve the patient quality of submitted to total pelvic exenteration for locally invasive life. However, there are still cases in which a reconstruction previously chemo-irradiated cervical cancer who presented is not possible at the time of resection; in all such cases, a six months after surgery with a severe enteroperineal fistula.
    [Show full text]
  • Detail Report
    Supplemental Update Report CR Number: 2012319113 Implementation Date: 16-Jan-19 Related CR: 2012319113 MedDRA Change Requested Add a new SMQ Final Disposition Final Placement Code # Proposed SMQ Infusion related reactions Rejected After Suspension MSSO The proposal to add a new SMQ Infusion related reactions is not approved after suspension. The ICH Advisory Panel did approve this SMQ topic to go into the development phase and it Comment: underwent testing in three databases (two regulatory authorities and one company). However, there were numerous challenges encountered in testing and the consensus decision of the CIOMS SMQ Implementation Working Group was that the topic could not be developed to go into production as an SMQ. Most notably, in contrast to other SMQs, this query could not be tested using negative control compounds because it was not possible to identify suitable compounds administered via infusion that were not associated with some type of reaction. In addition, there is no internationally agreed definition of an infusion related reaction and the range of potential reactions associated with the large variety of compounds given by infusion is very broad and heterogenous. Testing was conducted on a set of around 500 terms, the majority of which was already included in Anaphylactic reaction (SMQ), Angioedema (SMQ), and Hypersensitivity (SMQ). It proved difficult to identify potential cases of infusion related reactions in post-marketing databases where the temporal relationship of the event to the infusion is typically not available. In clinical trial databases where this information is more easily available, users are encouraged to provide more specificity about the event, e.g., by reporting “Anaphylactic reaction” when it is known that this event is temporally associated with the infusion.
    [Show full text]
  • 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]
  • 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.
    [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]
  • Femoral Injecting Guide
    FEMORAL INJECTING A GUIDE TO INJECTING IN THE GROIN USING THE FEMORAL VEIN (This is a restricted document NOT meant for general distribution) AUGUST 2006 1 INTRODUCTION INTRODUCTION This resource has been produced by some older intravenous drug users (IDU’s) who, having compromised the usual injecting sites, now inject into the femoral vein. We recognize that many IDU’s continue to use as they grow older, but unfortunately, easily accessible injecting sites often become unusable and viable sites become more dif- ficult to locate. Usually, as a last resort, committed IDU’s will try to locate one of the larger, deeper veins, especially when injecting large volumes such as methadone. ManyUnfortunately, of us have some had noof usalternat had noive alternative but to ‘hit butand to miss’ ‘hit andas we miss’ attempted as we attemptedto find veins to find that weveins couldn’t that we see, couldn’t but knew see, werebut knew there. were This there. was often This painful,was often frustrating, painful, frustrating, costly and, costly in someand, cases,in some resulted cases, inresulted permanent in permanent injuries such injuries as the such example as the exampleshown under shown the under the heading “A True Story” on pageheading 7. “A True Story” on page 7. CONTENTS CONTENTS 1) Introduction, Introduction, Contents contents, disclaimer 9) Rotating Injecting 9) Rotating Sites Injecting Sites 2) TheFemoral Femoral Injecting: Vein—Where Getting is Startedit? 10) Blood Clots 10) Blood Clots 3) FemoralThe Femoral Injecting: Vein— Getting Where
    [Show full text]
  • 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.
    [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]
  • Recognizing Common and Uncommon Birthmarks Harper N
    Doctor should I be worried? Recognizing common and uncommon birthmarks Harper N. Price, MD, FAAD, FAAP Division Chief, Fellowship Director Friday, June 28, 10:50-11:35am Conflicts of interest: • None Learning objectives • Recognize common and less common congenital skin lesions in the outpatient setting • RED Vascular lesions: capillary malformations, hemangiomas, vascular tumors • BROWN Pigmented lesions: congenital nevi • BLUE dermal melanoyctosis • YELLOW/TAN Benign hamartomas: nevus sebaceous, connective tissue nevi • Developmental anomalies: aplasia cutis, hair collar sign • Identify those congenital skin lesions that require urgent referral and additional investigations Red birthmarks Classification of vascular anomalies • Incorrect nomenclature misunderstanding between colleagues and with patients • Incorrect nomenclature misdiagnosis • Accurate diagnosis is crucial for appropriate evaluation and management • Classification serves as a guide for clinicians Archaic terms • “Strawberry hemangioma” • “Cavernous hemangioma” • “Capillary hemangioma” • Historically speaking “hemangioma” has been used for vascular tumors and malformations Wassef M et al. Pediatr 2015 A simpler version Puttgen KB. Pediatr Clin N Am. 2014 Infantile hemangiomas (IH): classic vascular “tumor” • 4-10% of infants, head and neck • Most common soft tissue tumor of infancy • Present first few weeks of life • Proliferation of benign endothelial cells • Initial rapid growth followed by slow involution Infantile hemangiomas: risk factors • Low birth weight infants
    [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]
  • 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.
    [Show full text]