groin injuries in hockey · groin injuries in sports dr. michael clarfield the sports medicine...
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GROIN INJURIES IN SPORTS
Dr. Michael ClarfieldThe Sports Medicine Specialists
Head Team Physician Toronto Maple Leafs 1989-2004
Physician NHLHead Physician National Ballet of Canada
Team Physician Tennis CanadaTeam Physician Spidertech UCI Pro Cycling
Team
EVALUATION AND TREATMENT OF GROIN PAIN
GROIN INJURIES
CLINICAL PRESENTATION
AND
DIFFERENTIALDIAGNOSIS
GROIN INJURIES-Groin Stain-High Groin Strain-Gilmores Groin-Hockey Players
Hernia-Slapshot Gut -Athletic Pubalgia-Sports Hernia-Sportsman Hernia
DIFFERENTIAL DIAGNOSISREFERRED PAIN
Back-Herniated Disc
Back-Other
Kidney Stones
DIFERENTIAL DIAGNOSISGastrointestinal
Genitouretal-testicle/prostate
Gynecological
Rheumatologic-Spondyloartropathy
DIFERENTIAL DIAGNOSISHIP DISORDERS
-Osteoarthritis-Labral tears-Stress Fractures-Synovitis/capsulitis-Slipped capital femoral epiphysis-AVN-FAI-Cam/Pincer
DIFERENTIAL DIAGNOSISPELVIC DISORDERS
-Osteitis Pubis
-Stress fractures
-Avulsion Fractures
DIFERENTIAL DIAGNOSISNERVE ENTRAPMENTS
-Ilioinguinal nerve
-Obturator Nerve
-Lateral femoral cutaneous nerve
-Genital branch genitalfemoral nerve
DIFFERENTIAL DIAGNOSISCLASSIC GROIN INJURIES
acute injuries insidious onset
ACUTE GROIN INJURIESMuscle / Muscle-tendon/Avulsion
-Abdominal-rectus/obliques-Adductor-adductors
-gracilis-pectineus
-Psoas
INSIDIOUS GROIN INJURIESPosterior wall of the inguinal canalTear of transversus abdominusDisruption of conjoined tendon(tendon of insertion of both internal oblique and transversus abdominus) dehiscence between tendon and the inguinal ligamentTear of internal oblique and external oblique aponeurosis of internal inguinal wall
INSIDIOUS GROIN INJURIESTear external oblique aponeurosisInguinal nerve entrapment
Attenuation rectus abdominis
X
PATHOPHYSIOLOGY
abdominal hyperextensionthigh hyperabductioneccentric adductor contraction
PATHOPHYSIOLOGY
ANATOMY-PELVIC REGION
PHYSICAL EXAMINATION
Isolate specific pathology
ADDUCTION
ADDUCTION
ADDUCTION/FLEXION
HIP FLEXION
PSOAS
PSOAS
HIP FLEXION
PSOAS
RECTUS/OBLIQUE
OBLIQUES/CONTRALATERAL
OBLIQUES/IPSILATERAL
TENDERNESS-INSERTIONCONJOINED TENDON
PECTINEUS
ADDUCTION/EXTENSION
MEDIAL HAMSTRINGS
IMAGINGX-RAYULTRASOUNDMRI/MRABONE SCANEMG
IRONY OF GROIN PAIN
POSITIVE FINDINGS-good results
NEGATIVE FINDINGS-poor results
GROIN CLASSIFICATION
TOPER
UNDRS
T O P E RT-TRAUMATIC
O-ONE SIDE OF PELVIS
P-POSITIVE FINDINGS
E-ECCENTRIC OVERLOAD
R-REHABILITATION
U N D R SU-UNKOWN/INSIDUOUS ONSET
N-NEGATIVE FINDINGS
D-DIFFUSE PAIN/BOTH SIDES OF PELVIS
R-REHABILITATION
S-SURGERY
TREATMENTCOSERVATIVE
SURGICAL
COSERVATIVE TREATMENTMAKE SPECIFIC DIAGNOSIS
TREAT PATHOLOGY
REHABILITATIONREDUCE INFLAMATION
CORECT PELVIC IMBALANCE
REDUCE SCAR TISSUE
RELEASE ADHESIONS
REHABILITATIONSTRENGTHEN CORE/PELVIS
STRENGTHEN HIP/LEGS
FLEXIBILITY
POTENTIATE REHAB
ANTI-INFLAMATORY MEDICATION
CORTICOSTEROID INJECTIONS
EXTRACAPORAL SHOCK WAVE THERAPYPLATELET RICH PLASMA
SUPPORTCOMPRESSION SHORTS
GROIN WRAP
Groin Injuries in Athletesoperative treatment
prevention
Groin Injuries - surgical repair
Repair rectus sheath; external obliqueMesh - abdominal wall repairRelease adductor tendon
Groin Injuries - surgical repair
Groin Injuries - surgical repair
Groin Injuries - Post operative
Rest six weeksPhysiotherapy, soft tissue workStrengthening, core stability
Groin Injuries in Athletes
6 months excellent rehab.diagnosis - investigation
groin repairpost operative rehab.
prevention
90% good…
…but only 60% cured!
PREVENTIONAdductor/abductor strength <80%History of previous groin injuryAgeLow number sport specific off-season training sessions
Lower abdominal/core dynamic programs
Thank you