groin injuries in hockey · groin injuries in sports dr. michael clarfield the sports medicine...

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