THE GROIN REGION ANATOMY AND CLINICAL ANATOMICAL APPROACH TO ATHLETIC GROIN PAIN REVIEW OF LITERATURE
Year 2023,
, 25 - 33, 13.10.2023
Hürriyet Ercan Çetinok
,
Büşra Sancaklı
Abstract
The anatomy of the groin region is complex and involves a confluence of structures. Groin pain is a chronic symptom located in the inguinal region. In this review, it is aimed to give an overview of inguinal pain in the literature, to examine surgical and rehabilitation interventions and to compare the time to return to sports. In addition, different diagnostic approaches are indicated. To create a map for further studies by compiling in detail the studies in the literature on the anatomy of the groin region and the definition, treatment and return to sports after the treatment of athletic groin pain. The results of this review showed a comparable return to play rate and return to play time between surgical and rehabilitative interventions. We believe that dealing with the reasons of groin pain in detail in the treatment process will affect the duration of treatment and return to play.
References
- Falvey ÉC, King E, Kinsella S, et al. Athletic groin pain (part 1): a prospective anatomical diagnosis of 382 patients—clinical findings, MRI findings and patient-reported outcome measures at baseline British Journal of Sports Medicine 2016;50: 423-430.
- Serner A, van Eijck CH, Beumer BR, Hölmich P, Weir A, de Vos RJ. Study quality on groin injury management remains low: a systematic review on treatment of groin pain in athletes. Br J Sports Med. 2015 Jun;49(12):813.
- Hölmich P. Groin injuries in athletes--development of clinical entities, treatment, and prevention. Dan Med J. 2015;62(12):B5184.
- King E, Ward J, Small L, Falvey E, Franklyn-Miller A. Athletic groin pain: a systematic review and meta-analysis of surgical versus physical therapy rehabilitation outcomes. Br J Sports Med. 2015 Nov;49(22):1447-51.
- Delahunt E, Thorborg K, Khan KM, et al Minimum reporting standards for clinical research on groin pain in athletes British Journal of Sports Medicine 2015;49:775-781.
- Pålsson A, Kostogiannis I, & Ageberg E. Physical impairments in longstanding hip and groin pain: Cross-sectional comparison of patients with hip-related pain or non-hip-related groin pain and healthy controls. Physical Therapy in Sport, 2021; 52, 224–233.
- Hu QL, Chen DC. Approach to the Patient with Chronic Groin Pain. Surgical Clinics of North America, 2018; 98(3), 651–665.
- Kalebo P, Karlsson J, Sward L, Peterson L. Ultrasonography of chronic tendon injuries in the groin. Am J Sports Med 1992; 20: 634–639.
- Weir A, Jansen JA, van de Port IG, Van de Sande HB, Tol JL, Backx FJ. Manual or exercise therapy for long-standing adductor-related groin pain: a randomised controlled clinical trial. Man Ther. 2011 Apr;16(2):148-54.
- Robertson BA, Barker PJ, Fahrer M, Schache AG. The anatomy of the pubic region revisited: implications for the pathogenesis and clinical management of chronic groin pain in athletes. Sports Med. 2009;39(3):225-234.
- Elattar O, Choi HR, Dills VD, Busconi B. Groin Injuries (Athletic Pubalgia) and Return to Play. Sports Health. 2016;8(4):313-323.
- Rab M, Ebmer And J, Dellon AL. Anatomic variability of the ilioinguinal and genitofemoral nerve: implications for the treatment of groin pain. Plast Reconstr Surg 2001;108(6):1618–23.
- Amid PK, Hiatt JR. New understanding of the causes and surgical treatment of postherniorrhaphy inguinodynia and orchalgia. J Am Coll Surg 2007;205(2): 381–5.
- Falvey EC, Franklyn-Miller A, McCrory PR The groin triangle: a patho-anatomical approach to the diagnosis of chronic groin pain in athletes British Journal of Sports Medicine 2009;43:213-220.
- Hopkins C. Standring S, editor. Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 41st ed. Philadelphia: Elsevier Limited; 2016.
- Ekstrand J, Gillquist J. Soccer injuries and their mechanisms: a prospective study. Med Sci Sports Exerc. 1983;15(3):267-70.
- Nielsen AB, Yde J. Epidemiology and traumatology of injuries in soccer. Am J Sports Med. 1989 Nov-Dec;17(6):803-7.
- Engström B, Forssblad M, Johansson C, et al. Does amajor knee injury definitely sideline an elite soccer player? Am J Sports Med 1990 Jan-Feb; 18: 101-5
- Renström P, Peterson L. Groin injuries in athletes. Br J Sports Med. 1980 Mar;14(1):30-6.
- Lovell G. The diagnosis of chronic groin pain in athletes: a review of 189 cases. Aust J Sci Med Sport 1995; 27: 76-9
- Suarez, Juan C. MD; Ely, Erin E. MD; Mutnal, Amar B. MD; Figueroa, Nathania M. MD; Klika, Alison K. MS; Patel, Preetesh D. MD; Barsoum, Wael K. MD. Comprehensive Approach to the Evaluation of Groin Pain. Journal of the American Academy of Orthopaedic Surgeons: September 2013 - Volume 21 - Issue 9 - p 558-570.
- Lynch SA, Renström PA. Groin injuries in sport: treatment strategies. Sports medicine (Auckland, N.Z.) 1999; 28(2), 137–144.
- Holmich P. Adductor related groin pain in athletes. Sports Medicine and Arthroscopy Review 1997;5(4):285-91.
- Paajanen H, Syvahuoko I, Airo I. Totally extraperitoneal endoscopic (TEP) treatment of sportsman’s hernia. Surg Laparosc Endosc Percutan Tech 2004; 14: 215–218.
- Martens MA, Hansen L, Mulier JC. Adductor tendinitis and musculus rectus abdominis tendopathy. Am J Sports Med 1987; 15: 353–356.
- Holmich P. Long-standing groin pain in sportspeople falls into three primary patterns, a "clinical entity" approach: a prospective study of 207 patients. Br.J.Sports Med. 2007;41(4):247-52
- Hölmich P, Uhrskou P, Ulnits L, Kanstrup IL, Bachmann Nielsen M, Bjerg AM, Krogsgaarda K. Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: Randomised trial. Lancet, 1999; 353(9151), 439–443.
- Rolph R, Morgan C, Chapman G, Marsh S. Groin pain in athletes [published correction appears in BMJ. 2021 Nov 16;375: n2805]. BMJ. 2020;368:m559.
- McSweeney SE, Naraghi A, Salonen D, Theodoropoulos J, White LM. Hip and groin pain in the professional athlete. Can Assoc Radiol J. 2012 May;63(2):87-99.
- Fricker P, Taunton J, Ammann W. Osteitis pubis in athlete: infection, inflammation or injury? Sports Med 1991: 12: 266–279.
- Rodriguez C, Miguel A, Lima H, Heinrichs K. Osteitis pubis syndrome in the professional soccer athlete: a case report. J Athl Train 2001: 36: 437–440.
- Ekstrand J, Ringborg S. Surgery versus conservative treatment in soccer players with chronic groin pain: a prospective randomised study in soccer players. Eur J Sports Traumatol Rel Res 2001: 23: 141–145.
- Holt MA, Keene JS, Graf BK, Helwig DC. Treatment of osteitis pubis in athletes: results of corticosteroid injections. Am J Sports Med 1995: 23: 601–606.
- O’Connell MJ, Powell T, McCaffrey NM, O’Connell D, Eustace SJ. Symphyseal cleft injection in the diagnosis and treatment of osteitis pubis in Athletes. Am J Roentgen 2002: 179: 955–959.
- Topol GA, Reeves KD, Hassanein KM. Efficacy of dextrose prolotherapy in elite male kicking-sport athletes with chronic groin pain. Arch Phys Med Rehabil 2005: 86: 697–702.
- Akermark C, Johansson C. Tenotomy of the adductor longus tendon in the treatment of chronic groin pain in athletes. Am J Sports Med 1992: 20: 640–643.
- Ingoldby CJ. Laparoscopic and conventional repair of groin disruption in sportsmen. Br J Surg 1997; 84: 213–215.
- Genitsaris M, Goulimaris I, Sikas N. Laparoscopic repair of groin pain in athletes. Am J Sports Med 2004; 32: 1238–1242.
- Van Veen RN, de Baat P, Heijboer MP, Kazemier G, Punt BJ, Dwarkasing RS, Bonjer HJ, van Eijk CHJ. Successful endoscopic treatment of chronic groin pain in athletes. Surg Endosc 2007; 21: 189–193.
- Williams PR, Thomas DP, Downes EM. Osteitis pubis and instability of the pubic symphysis: when nonoperative measures fail. Am J Sports Med 2000; 28: 350–355.
- Paajanen H, Brinck T, Hermunen H, Airo I. Laparoscopic surgery for chronic groin pain in athletes is more effective than nonoperative treatment: a randomized clinical trial with magnetic resonance imaging of 60 patients with sportsman's hernia (athletic pubalgia). Surgery. 2011 Jul;150(1):99-107.
Inguinal Bölge Anatomisi Ve Atletik Pubaljiye Klinik Anatomik Yaklaşim ile Literatür İncelemesi
Year 2023,
, 25 - 33, 13.10.2023
Hürriyet Ercan Çetinok
,
Büşra Sancaklı
Abstract
Inguinal Bölge anatomisi karmaşıktır ve çeşitli yapıların organizasyonunu içerir. Pubalji kasık bölgesinde lokalize olan kronik bir semptomdur. Bu derlemede pubalji konusunda literatürde yer alan genel bilgilerin verilmesi, cerrahi ve rehabilitasyon müdahalelerinin incelenmesi ile spora dönüş sürelerinin karşılaştırılması amaçlanmaktadır. Ayrıca farklı tanı yaklaşımları belirtilmektedir. Inguinal bölgenin anatomisi ve atletik pubaljinin tanımı, tedavisi ve tedavi sonrası spora dönüş konularında literatürde yer alan çalışmaları detaylı bir şekilde derleyerek ileriki çalışmalar için bir harita oluşturmaktır. Bu derlemenin sonuçları, cerrahi ve rehabilitasyon müdahaleleri arasında spora dönüş oranı ve süresinin karşılaştırılabilir olduğunu göstermiştir. Tedavi sürecinde pubalji nedenlerinin detaylı olarak ele alınmasının tedavi süresini ve spora dönüş süresini etkileyeceği belirtilmştir.
References
- Falvey ÉC, King E, Kinsella S, et al. Athletic groin pain (part 1): a prospective anatomical diagnosis of 382 patients—clinical findings, MRI findings and patient-reported outcome measures at baseline British Journal of Sports Medicine 2016;50: 423-430.
- Serner A, van Eijck CH, Beumer BR, Hölmich P, Weir A, de Vos RJ. Study quality on groin injury management remains low: a systematic review on treatment of groin pain in athletes. Br J Sports Med. 2015 Jun;49(12):813.
- Hölmich P. Groin injuries in athletes--development of clinical entities, treatment, and prevention. Dan Med J. 2015;62(12):B5184.
- King E, Ward J, Small L, Falvey E, Franklyn-Miller A. Athletic groin pain: a systematic review and meta-analysis of surgical versus physical therapy rehabilitation outcomes. Br J Sports Med. 2015 Nov;49(22):1447-51.
- Delahunt E, Thorborg K, Khan KM, et al Minimum reporting standards for clinical research on groin pain in athletes British Journal of Sports Medicine 2015;49:775-781.
- Pålsson A, Kostogiannis I, & Ageberg E. Physical impairments in longstanding hip and groin pain: Cross-sectional comparison of patients with hip-related pain or non-hip-related groin pain and healthy controls. Physical Therapy in Sport, 2021; 52, 224–233.
- Hu QL, Chen DC. Approach to the Patient with Chronic Groin Pain. Surgical Clinics of North America, 2018; 98(3), 651–665.
- Kalebo P, Karlsson J, Sward L, Peterson L. Ultrasonography of chronic tendon injuries in the groin. Am J Sports Med 1992; 20: 634–639.
- Weir A, Jansen JA, van de Port IG, Van de Sande HB, Tol JL, Backx FJ. Manual or exercise therapy for long-standing adductor-related groin pain: a randomised controlled clinical trial. Man Ther. 2011 Apr;16(2):148-54.
- Robertson BA, Barker PJ, Fahrer M, Schache AG. The anatomy of the pubic region revisited: implications for the pathogenesis and clinical management of chronic groin pain in athletes. Sports Med. 2009;39(3):225-234.
- Elattar O, Choi HR, Dills VD, Busconi B. Groin Injuries (Athletic Pubalgia) and Return to Play. Sports Health. 2016;8(4):313-323.
- Rab M, Ebmer And J, Dellon AL. Anatomic variability of the ilioinguinal and genitofemoral nerve: implications for the treatment of groin pain. Plast Reconstr Surg 2001;108(6):1618–23.
- Amid PK, Hiatt JR. New understanding of the causes and surgical treatment of postherniorrhaphy inguinodynia and orchalgia. J Am Coll Surg 2007;205(2): 381–5.
- Falvey EC, Franklyn-Miller A, McCrory PR The groin triangle: a patho-anatomical approach to the diagnosis of chronic groin pain in athletes British Journal of Sports Medicine 2009;43:213-220.
- Hopkins C. Standring S, editor. Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 41st ed. Philadelphia: Elsevier Limited; 2016.
- Ekstrand J, Gillquist J. Soccer injuries and their mechanisms: a prospective study. Med Sci Sports Exerc. 1983;15(3):267-70.
- Nielsen AB, Yde J. Epidemiology and traumatology of injuries in soccer. Am J Sports Med. 1989 Nov-Dec;17(6):803-7.
- Engström B, Forssblad M, Johansson C, et al. Does amajor knee injury definitely sideline an elite soccer player? Am J Sports Med 1990 Jan-Feb; 18: 101-5
- Renström P, Peterson L. Groin injuries in athletes. Br J Sports Med. 1980 Mar;14(1):30-6.
- Lovell G. The diagnosis of chronic groin pain in athletes: a review of 189 cases. Aust J Sci Med Sport 1995; 27: 76-9
- Suarez, Juan C. MD; Ely, Erin E. MD; Mutnal, Amar B. MD; Figueroa, Nathania M. MD; Klika, Alison K. MS; Patel, Preetesh D. MD; Barsoum, Wael K. MD. Comprehensive Approach to the Evaluation of Groin Pain. Journal of the American Academy of Orthopaedic Surgeons: September 2013 - Volume 21 - Issue 9 - p 558-570.
- Lynch SA, Renström PA. Groin injuries in sport: treatment strategies. Sports medicine (Auckland, N.Z.) 1999; 28(2), 137–144.
- Holmich P. Adductor related groin pain in athletes. Sports Medicine and Arthroscopy Review 1997;5(4):285-91.
- Paajanen H, Syvahuoko I, Airo I. Totally extraperitoneal endoscopic (TEP) treatment of sportsman’s hernia. Surg Laparosc Endosc Percutan Tech 2004; 14: 215–218.
- Martens MA, Hansen L, Mulier JC. Adductor tendinitis and musculus rectus abdominis tendopathy. Am J Sports Med 1987; 15: 353–356.
- Holmich P. Long-standing groin pain in sportspeople falls into three primary patterns, a "clinical entity" approach: a prospective study of 207 patients. Br.J.Sports Med. 2007;41(4):247-52
- Hölmich P, Uhrskou P, Ulnits L, Kanstrup IL, Bachmann Nielsen M, Bjerg AM, Krogsgaarda K. Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: Randomised trial. Lancet, 1999; 353(9151), 439–443.
- Rolph R, Morgan C, Chapman G, Marsh S. Groin pain in athletes [published correction appears in BMJ. 2021 Nov 16;375: n2805]. BMJ. 2020;368:m559.
- McSweeney SE, Naraghi A, Salonen D, Theodoropoulos J, White LM. Hip and groin pain in the professional athlete. Can Assoc Radiol J. 2012 May;63(2):87-99.
- Fricker P, Taunton J, Ammann W. Osteitis pubis in athlete: infection, inflammation or injury? Sports Med 1991: 12: 266–279.
- Rodriguez C, Miguel A, Lima H, Heinrichs K. Osteitis pubis syndrome in the professional soccer athlete: a case report. J Athl Train 2001: 36: 437–440.
- Ekstrand J, Ringborg S. Surgery versus conservative treatment in soccer players with chronic groin pain: a prospective randomised study in soccer players. Eur J Sports Traumatol Rel Res 2001: 23: 141–145.
- Holt MA, Keene JS, Graf BK, Helwig DC. Treatment of osteitis pubis in athletes: results of corticosteroid injections. Am J Sports Med 1995: 23: 601–606.
- O’Connell MJ, Powell T, McCaffrey NM, O’Connell D, Eustace SJ. Symphyseal cleft injection in the diagnosis and treatment of osteitis pubis in Athletes. Am J Roentgen 2002: 179: 955–959.
- Topol GA, Reeves KD, Hassanein KM. Efficacy of dextrose prolotherapy in elite male kicking-sport athletes with chronic groin pain. Arch Phys Med Rehabil 2005: 86: 697–702.
- Akermark C, Johansson C. Tenotomy of the adductor longus tendon in the treatment of chronic groin pain in athletes. Am J Sports Med 1992: 20: 640–643.
- Ingoldby CJ. Laparoscopic and conventional repair of groin disruption in sportsmen. Br J Surg 1997; 84: 213–215.
- Genitsaris M, Goulimaris I, Sikas N. Laparoscopic repair of groin pain in athletes. Am J Sports Med 2004; 32: 1238–1242.
- Van Veen RN, de Baat P, Heijboer MP, Kazemier G, Punt BJ, Dwarkasing RS, Bonjer HJ, van Eijk CHJ. Successful endoscopic treatment of chronic groin pain in athletes. Surg Endosc 2007; 21: 189–193.
- Williams PR, Thomas DP, Downes EM. Osteitis pubis and instability of the pubic symphysis: when nonoperative measures fail. Am J Sports Med 2000; 28: 350–355.
- Paajanen H, Brinck T, Hermunen H, Airo I. Laparoscopic surgery for chronic groin pain in athletes is more effective than nonoperative treatment: a randomized clinical trial with magnetic resonance imaging of 60 patients with sportsman's hernia (athletic pubalgia). Surgery. 2011 Jul;150(1):99-107.