Groin Pain Syndrome: A Multidisciplinary Guide to Diagnosis and Treatment

178 Pages·2017·11.005 MB·English

by  Raul Zini, Piero Volpi, Gian Nicola Bisciotti (eds.)

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
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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