Comprehensive Approach to the Evaluation of Groin Pain

Suárez, Juan C.; Ely, Erin E.; Mutnal, Amar; Figueroa, Nathania M.; Klika, Alison K.; Patel, Preetesh D.; Barsoum, Wael K.

doi:10.5435/00124635-201309020-00007

Cited by 9 publications

(17 citation statements)

References 37 publications

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“…It is both highly sensitive and specific for detecting many abnormalities involving the surrounding soft tissues and should, in general, be the first imaging technique used after radiographs [21][22][23][24][25][26][27][28][30][31][32]36,37]. MRI is useful for examining surrounding soft tissue entities such as iliopsoas or subiliacus bursitis, athletic pubalgia, trochanteric bursitis, abductor tendinosis or tears, calcific tendonitis, and hamstring injuries and for sources of referred pain from spine or knee [3]. Some secondary signs may suggest snapping hip syndrome (coxa sultans) [38].…”

Section: Discussion Of Imaging Modalities By Variantmentioning

confidence: 99%

“…☢☢ X-ray hip 9 X-ray pelvis and x-ray hip are complementary. [1][2][3]. Referred pain from the lumbar spine, sacroiliac joints, or knee may add to the potentially confusing clinical picture [4].…”

Section: Radiologic Proceduresmentioning

confidence: 99%

“…Clinical data are essential for selecting the most appropriate imaging techniques in patients with chronic hip pain. A targeted history and physical examination, including provocative maneuvers, range of motion, gait abnormalities, locking or snapping, duration of symptoms, and pain patterns (eg, worse at night and relieved by aspirin typical of osteoid osteoma, or steroid use as a cause of osteonecrosis [ON]), can be very useful for reducing the potentially long list of differential diagnoses [3,5]. Similar attention must be paid to the knees and spine as potential sources of pain.…”

Section: Radiologic Proceduresmentioning

confidence: 99%

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ACR Appropriateness Criteria ® Chronic Hip Pain

Mintz¹,

Baccei²

2017

Journal of the American College of Radiology

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Chronic hip pain is a common clinical problem whose cause is often elucidated by imaging. The ACR Appropriateness Criteria for chronic hip pain define best practices of image ordering. Clinical scenarios are followed by the imaging choices and their appropriateness. The information is in ordered tables with an accompanying narrative explanation to guide physicians to order the right test. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

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Section: Discussion Of Imaging Modalities By Variantmentioning

confidence: 99%

Section: Radiologic Proceduresmentioning

confidence: 99%

Section: Radiologic Proceduresmentioning

confidence: 99%

See 1 more Smart Citation

ACR Appropriateness Criteria ® Chronic Hip Pain

Mintz¹,

Baccei²

2017

Journal of the American College of Radiology

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“…Primary injury to the nerves can also be caused by stretching, partial cutting, or injury from electrocautery. Non-neuropathic pain is not primarily related to nerve injury, but develops secondary, as a result of excessive scarring of tissue around the mesh or an inappropriate inflammatory response (14). It is important, during the suturing of the mesh, that the surgeon does not set the suture too deep in the periost of the pubic tubercle.…”

Section: Discussionmentioning

confidence: 99%

“…Differential diagnosis of chronic inguinal pain includes musculoskeletal groin disorders like bursitis, tendinitis, osteoarthritis, avascular necrosis of the femoral head and avulsion fractures. Also, there are many nonorthopaedic conditions which can manifest as inguinal pain, such as urinary tract infections, lymphadenitis, hydrocaele, varicocaele, scrotal masses, kidney stones and polycystic ovaries (14). The objective of this study is to show the incidence and characteristics of chronic groin pain after inguinal hernia repair using different types of prolene mesh.…”

Section: Introductionmentioning

confidence: 99%

The Incidence and Characteristics of Chronic Postoperative Groin Pain after Inguinal Hernia Repair with Different Types of Prolene Mesh

Grebić¹,

Marija²,

Valenčić³

et al. 2015

West Indian Med J

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Objective: The objective of this study is to show the incidence and characteristics of chronic groin pain after inguinal hernia repair using different types of prolene mesh. Methods: The study was undertaken at the Department of Surgery, Clinical Hospital Centre Rijeka, and included 180 patients who had undergone inguinal hernia repair six to eight months prior to examination. Inguinal canal plasty had been done in 90 patients using a small-pored prolene mesh and in 90 patients using a large-pored prolene mesh. Every patient had undergone the Lichtenstein technique and preservation of inguinal nerves. Patients who felt pain were invited to complete a pain quality assessment scale (PQAS) with 20 items scored on a 0 to 10 numeric rating scale. Results: In the group of patients who had undergone inguinal canal plasty using a small-pored prolene mesh, 16 (18%) of the 90 patients had chronic postoperative groin pain. In the group of patients (90 patients) that had undergone inguinal canal plasty using a large-pored prolene mesh, none expressed chronic postoperative groin pain. The Pain Quality Assessment Scale is divided into three sub-scales. The first sub-scale evaluates paroxysmal pain. The mean value on this sub-scale was 2.56, which pertains to mild pain. The second sub-scale examines superficial pain, which had a mean value of 2.08, and the third subscale evaluates deep pain, which had a mean value of 1.89. All values pertained to mild pain. Conclusion: Using small-pored mesh for inguinal hernia repair increases the incidence of postoperative groin pain.

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Hip Adductor Longus Tendon Origin Anatomy Is Consistent and May Inform Surgical Reattachment

Perrone

Noorzad

Hamula

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To define the topographic anatomy of the footprint of the adductor longus origin on the pubis and its underlying bony morphology to better inform surgical repair of adductor longus tendon injuries. Methods Five cadaveric pelvis specimens were dissected, making 10 adductor footprints available for analysis. The adductor longus tendon origin was isolated and the surrounding tissue debrided. The circumference of the tendinous attachment to the pubic crest was marked before excising the tendon and fibrocartilage enthesis from the pubis. Radiopaque paint was prepared by mixing 30 mL of all-purpose acrylic paint (Anita’s no. 11150 Island Blue; Rust-Oleum Corp, Vernon Hills, IL) with 15g of E-Z-HD 98% w/w barium sulfate (Bracco Diagnostics Inc., Anjou Quebec, Canada) and applied to the marked footprint. The specimens underwent a 1.0-mm slice computed tomographic scan with 3-dimensional reconstructions. Synapse PACS (FujiFilm, Valhalla, NY) software for measurements of the tendon footprint and underlying bone. Results Average age and weight of the specimens at the time of death was 37 years and 204.6 ± 48.7 lbs, respectively. The width and length of the tendon origin was 12.0 ± 1.1 mm and 10.9 ± 1.1 mm, respectively. The distance of the center of the footprint from the center of the pubic tubercle was 8.5 ± 1.4 mm lateral and 12.2 ± 0.4 mm caudal. The osseous thickness underlying the footprint was 18.7 ± 3.7 mm at an angle of 34.5 ± 1.5° in relation to the sagittal plane. The correlation between specimen body weight and the thickness of the bone underlying the footprint was strongly positive (r = 0.92). Conclusions We found that there is a consistent angle from the center of the adductor longus tendon footprint to the point of maximal underlying bony thickness, as well as a positive correlation between body mass index and osseous thickness, which may inform anatomic reattachment of this tendon. Clinical Relevance Our findings will assist surgeons in identifying the footprint of the adductor longus tendon and safely perform anatomic repair of adductor longus tendon avulsions.

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Comprehensive Approach to the Evaluation of Groin Pain

Cited by 9 publications

References 37 publications

ACR Appropriateness Criteria ® Chronic Hip Pain

ACR Appropriateness Criteria ® Chronic Hip Pain

The Incidence and Characteristics of Chronic Postoperative Groin Pain after Inguinal Hernia Repair with Different Types of Prolene Mesh

Hip Adductor Longus Tendon Origin Anatomy Is Consistent and May Inform Surgical Reattachment

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