Presenter: Dr. Neil Dilworth – UofT Primary Care Sports Medicine Journal Club Director Date: June 9, 2015 Special Guest: Dr. Lloyd Smith Chief of General Surgery at North York General Hospital
1) Paajanen H, Brinck T, Hermunen H, Airo I (2011) Laparoscopic surgery for chronic groin pain in athletes is more effective than nonoperative treatment: a randomized clinical trial with magnetic resonance imaging of 60 patients with sportsman’s hernia (athletic pubalgia). Surgery 150(1):99–107
2) Santilli OL, Nardelli N, Santilli HA, Tripoloni DE.Sports hernias: experience in a sports medicine center. Hernia. 2015 Mar 18.
Background Definitions of Sport Hernia: Definitions: Gilmore’s groin – combination of a torn external oblique aponeurosis, a torn conjoined tendon, and dehiscence between the inguinal ligament and the torn conjoined tedon. Taylor – pubalgia – result of musculotendinous strains of adductor muscle and other muscles in the absence of an inguinal hernia. Meyers – Pubic serves as a point into which both the adductor muscles and rectus abdominis insert causing one muscle to antagonize the other, leading to an injury of the weaker muscles. 48% of his patients had an external oblique aponeurosis defect, 17% had a “thin” rectus abdominus insertion in 17% Paajanen – abnormalitiy of conjoint tendon, tendonopathy of inguinal ligament, incipient osteitis pubis
Paajanen Rehab Protocol post-surgical:
Post op days
Resume ADLs, abstain from lifting exercises. Begin walking and increase as tolerated
Post pelvic tiltMild resistive exercises – pool walking, partial squats, standing hip adduction/abduction/flexion/extension, heel raisingGentle stretching (Side bending, hip extension, psoas/groin/hamstring/quads)
Begin light jogging and deep tissue massage of adductor muscle belliesProgressive resistive exercises
Hip flexion, adduction, abduction, extensions (add wt. in 2 lb increments)Pool exercises (Running backward/forward, cariocas, side slides, jumping jacks – no arms, scissors, swimming-flutter kicks only)Jogging (1/2-1mile, including backwards)
Criteria for referral for Laparoscopic Repair for Sport hernia (Inguinal-related groin pain in Athlete in absence of a true hernia):
A. History features that must be present:
1) Athletic Injury – overuse/gradual onset.
2) Worse with twisting, sprinting, change of directions, and mechanical provocation.
3) Pain greater than 6 months ( > 6 weeks if professional/elite athlete)
B. Examination features that must be present:
1) Pain over inguinal ligaments and location of external and internal rings
2) Absence of true inguinal hernia
C. Imaging features that must be present:
1) Ultrasound – demonstrating no true inguinal hernia
2) MRI groin pain protocol – Negative for other causes of groin pain
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Paajanen H, Brinck T, Hermunen H, Airo I (2011) Laparoscopic surgery for chronic groin pain in athletes is more effective than nonoperative treatment: a randomized clinical trial with magnetic resonance imaging of 60 patients with sportsman’s hernia (athletic pubalgia). Surgery 150(1):99–107
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Santilli OL, Nardelli N, Santilli HA, Tripoloni DE.Sports hernias: experience in a sports medicine center. Hernia. 2015 Mar 18.