Groin Pain Syndrome: A Multidisciplinary Guide to Diagnosis and Treatment PDF
Preview Groin Pain Syndrome: A Multidisciplinary Guide to Diagnosis and Treatment
Raul Zini Piero Volpi Gian Nicola Bisciotti Editors Groin Pain Syndrome A Multidisciplinary Guide to Diagnosis and Treatment 123 Groin Pain Syndrome Raul Zini • Piero Volpi Gian Nicola Bisciotti Editors Groin Pain Syndrome A Multidisciplinary Guide to Diagnosis and Treatment Editors Raul Zini Gian Nicola Bisciotti Department of Orthopedic Surgery Kinemove Rehabilitation Center Maria Cecilia Hospital Pontremoli GVM Care and Research Massa Carrara Cotignola Italy Ravenna Italy Piero Volpi Knee Orthopaedic and Sport Traumatology Humanitas Research Hospital Rozzano Milan Italy ISBN 978-3-319-41623-6 ISBN 978-3-319-41624-3 (eBook) DOI 10.1007/978-3-319-41624-3 Library of Congress Control Number: 2017939588 © Springer International Publishing AG 2017 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Foreword Groin pain is a common complaint; notorious for the discomfort and disability it causes, it represents a diagnostic challenge for the orthopaedic surgeon. In clinical practice, we are frequently faced with this problem, especially when treating athletes participating in sports that require repetitive lower- limb movements, kicking, and sudden changes of speed and direction during the sporting activity. To better understand this challenging multifactorial condition, a compre- hensive approach is mandatory. Patients often refer to vague and diffuse symptoms that can be attributed to a variety of pathological entities; hence, the diagnosis and management of the underlying pathological processes remains a challenge. Furthermore, the pain is frequently not attributable to a single etiological cause, but is derived from the possible association of mul- tiple pathologies, thus requiring a differential diagnosis. The surgeon should carefully consider the differential diagnosis, as it is also important to take into account that groin pain can have musculoskeletal as well as visceral causes. This book, representing the latest updates of current knowledge on this subject, is an indispensable resource that will assist the reader to recognize and treat groin pain. The reader will also become acquainted with many aspects of basic science that have improved the differential diagnosis and treatment of this syndrome. The contributing authors are experts in the field and share with the reader their experiences and surgical insights. This book is a state-of-the-art guide for those starting in the field of groin pain syndrome, as well as for experi- enced specialists. Rome, Italy Vincenzo Denaro v Preface Groin pain syndrome is an important current clinical topic in sports medi- cine, but the syndrome is still not well known and its characteristics are debatable, while its patterns of diagnosis and treatment are often imprecise and fragmentary. The classification and identification of a diagnostic taxonomy for the syn- drome have not yet found a common interpretation. Therefore, gaining actual agreement among the different specialists that face the clinical issues of this entity is often difficult. The terminology used in the literature includes, often inappropriately, a very large number of terms and definitions. Therefore, there is a need to orga- nize and better classify the numerous clinical symptoms that can constitute groin pain; only in this way will it will be possible to reach a correct diagnosis and then provide the correct treatment. This syndrome covers a range of symptoms, localized in the groin area, that often have a multifactorial etiopathogenesis, and as a consequence, treat- ment will involve practitioners from different medical specialties. The syn- drome provides a clear example of how interaction and cooperation among different professional approaches, sharing patterns of diagnosis and proce- dures, may be fundamental in improving treatment. This book aims to summarize the state of the art in the treatment and diag- nosis of groin pain syndrome in an innovative way, considering the set of problems from different professional points of view and searching for a shared synthesis. In the first chapter, a new classification of groin pain syndrome is sug- gested for a more precise differential diagnosis; this is based on the results of the recent Consensus Conference, held in Milan on February 5, 2016, with the participation of major Italian experts in the field. The groin area is extremely complex, both from the anatomical and bio- mechanical points of view, and these topics will be analyzed, together with radiological diagnoses, to complete the introductory part of the book. The next part of the book describes orthopaedic pathologies that can cause groin pain; the different pathologies are examined both in terms of the diagnosis and in terms of the relevant treatment; we focus on labrum lesions; chondral damage; and pathologies of the central, peripheral, and peritrochanteric compartments. The main pathology that causes groin pain is certainly femoroacetabular impingement, and above all, cam impingement, where a femoral bump leads vii viii Preface to an articular conflict between femur and acetabulum, with associated bio- mechanical alteration; this produces compensatory stresses in other anatomi- cal areas, such as the pubic symphysis, the sacroiliac joint, and the abdominal lining. Also, groin pain can often be caused by visceral pathologies that are very important to understand and evaluate. The so-called sports hernia is quite frequent in sportsmen, and is often not well diagnosed or well treated. Therefore, there is a need for correct diagnos- tic and therapeutic approaches; these are explained in Part II of this book. Many tendon and muscle pathologies are also a frequent cause of groin pain, and in Part III of this book, these are discussed in depth, with particular attention paid to the adductor tendons, ileopsoas tendons, and abdominal muscles that can frequently be involved in atypical groin pain. The pubic bone, both at the symphyseal joint and in the bone itself, can be the target area of compensatory stress, and therefore all possible pubic pathologies are examined. Furthermore, we must never underestimate the neurological causes of groin pain, such as those that are well identified in the so-called nerve entrap- ment syndrome; these causes are discussed and investigated. The end of the book contains chapters dedicated to rehabilitation; conser- vative rehabilitation is discussed above all, with particular attention given to strengthening and stretching exercises, physical therapy, and hydrotherapy. With regard to postoperative rehabilitation, different chapters will discuss rehabilitation after arthroscopic hip surgery, abdominal surgery, and tendon surgery, with indications and in-depth analysis of the most up-to-date and efficient protocols. I believe that, in the long run, this book will make a complete and thorough contribution to a multidisciplinary approach to the groin pain syndrome, and may therefore help specialists in different fields to better understand the vari- ous and often overlapping causes of groin pain. The scientific co-operation of distinguished international and Italian experts, whom I kindly thank for their important contributions, has allowed us to reach our target; that is, to define the state of the art in our knowledge of the groin pain syndrome and then to suggest new diagnostic, therapeutic, and organizational models for the condition. Cotignola, Ravenna, Italy Raul Zini Contents Part I Introduction 1 Classification and Differential Analysis of Groin Pain Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Gian Nicola Bisciotti and Piero Volpi 2 Inguinal Region Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Umile Giuseppe Longo, Vincenzo Candela, Giuseppe Salvatore, Mauro Ciuffreda, Alessandra Berton, and Vincenzo Denaro 3 Physiology and Biomechanics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Papalia Rocco, Vasta Sebastiano, Torre Guglielmo, Ciuffreda Mauro, and Denaro Vincenzo 4 Radiologic Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Alessio Auci Part II Hip Pathology 5 Femoroacetabular Impingement . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Raul Zini and Manlio Panascì 6 Acetabular Labral Tear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Christoph Gebhart 7 Pathology of Central Compartment . . . . . . . . . . . . . . . . . . . . . . . 61 Nicolas Bonin and Antoine Dangin 8 Hip Cartilage Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Piero Volpi, Raul Zini, Alessandro Quaglia, and Manlio Panascì 9 Extra-articular Hip Pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Raul Zini and Manlio Panascì Part III Visceral Pathology 10 Inguinal Hernia and Other Types of Hernia: Diagnostic and Therapeutic Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Francesco Di Marzo ix x Contents 11 Urogenital Pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Massimo Cecchi Part IV Tendon/Muscle Pathology 12 Sports Hernia: Diagnostic and Therapeutic Approach . . . . . . . 103 Antonio Guglielmi 13 Sports Hernia: A Comparison of the Different Surgical Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Francesco Di Marzo 14 Adductor and Upright Abdominal Tendinopathy . . . . . . . . . . . 117 Gian Luigi Canata and Valentina Casale 15 Iliopsoas Tendinopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Gianni Nanni Part V Bone Pathology 16 Osteitis Pubis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Gianluca Melegati and Sara Elli Part VI Neurologic Pathology 17 Nerve Entrapment Syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Giancarlo Barolat Part VII Rehabilitation 18 Conservative Rehabilitation Treatment in Groin Pain Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Ilaria Maria Marchetti, Cristiano Sconza, and Stefano Respizzi 19 Postsurgical Rehabilitation: FAI . . . . . . . . . . . . . . . . . . . . . . . . . 167 Maria Teresa Pereira Ruiz 20 Postsurgical Rehabilitation: Hernioplasty . . . . . . . . . . . . . . . . . 173 Simona Cerulli 21 Postsurgical Rehabilitation: Tendon Surgery. . . . . . . . . . . . . . . 179 Rita Guitalti and Maria Teresa Pereira Ruiz Part VIII Conclusion 22 Groin Pain Syndrome: A Final Assessment of the State of the Art . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187 Raul Zini, Piero Volpi, and Gian Nicola Bisciotti Part 1 Introduction
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