Groin pain Flashcards
What are 4 risk factors for tendinopathy?
o Higher age o Gender o Individual genetic composition o Abnormal kinematics o Reduced elasticity of the muscle o Overweight o Reduced eccentric muscle strength o Sport, training and surface
Why does the Achilles tendon not have a tendinitis
(generally)?
- no inflammatory cells in Achilles tendon
it has ingrowth of blood vessels, more innervation, glutamate which makes it painful
Explain the stages of tendinopathy.
Stage 1: Slight pain after exercise that generally disappears after some hours
Stage 2: Moderate pain at the beginning of exercise and after. The complaints last longer as well.
Stage 3: Pain at the beginning of exercise that does go down during exercise, but does not disappear entirely. After exercising the pain may last for days.
Stage 4: Pain that arises during exercise, so severe that the sport/work performance suffers.
Stage 5: Continuous pain, also when resting.
-Stage 6: Rupture; this stage is arbitrary because often a tendon rupture takes place without preceding complaints.
When does the collagen synthesis and collagen degradation balance out in a tendon after sports?
After 36 hours
Nelson recovered from a tendon injury recently. He wants to go back to playing soccer, but the first time he joined the training he felt pain again. In which stage is the patient according to the model of Cook & Purdam
Reactive tendinopathy
Nelson was in the stage of tendon disrepair in the Model of Cook & Purdam. What does he have to do to recover?
Take rest, stop training and slowly increase load when exercising again.
What do you focus on if the patient is in the degenerative tendinopathy phase in your treatment?
you focus on the donut not the hole: focus on treating the tissue which is still intakt instead of the tissue which is already in degeneration.
What does the Iceberg model by Fredberg represent for tendinopathy?
(why is a tendinopathy also called iceberg tendinopathy?)
If in constant overload, there are already changes in the tendon before symptoms show.
With an iceberg in the sea you only see the top. Therefore, when a patient has symptoms, the tendinopathy may have started already a lot earlier.
What are characteristics for the Cam-type impingement and the Pincer-type impingement?
Cam morphology: - extra bone formation at femoral head due to vigorous loading of the hip when the growth plate is still open (children + teenagers) Pincer type: - deep / retroverted acetabulum - the femoral head gets covered too much
Which incidence has Cam- morphology?
- 25% in non-athletes
- 66% in athletes
What does FAI stand for?
Femoro-acetabular impingement
What are symptoms of FAI?
- ROM adduction & internal rotation limitation
- muscle strength reduction
- catching, giving way, locking
- prolonged sitting/ periods of flexion causes pain
´Which 2 diagnostic test can you think of to test FAI?
- FADDIR
* FABER
Is the FADDIR test an exclusion or inclusion test?
exclusion test, due to 99% sensitivity Snout rule (high sensitivity --> rules out)
What is the agreement called which defines groin pain?
The Doha agreement
Name 3 symptoms of inguinal-related groin pain.
Inguinal tenderness Pain in inguinal canal region No palpatable hernia Pain aggravated by resistance test for abdominal muscles (Valsalva (nerve) cough- sneeze test)
What does LAGP stand for?
Long-standing adductor-realted groin pain
What does the abbreviation ‘FABER’ stand for?
FABER = flexion, abduction, external rotation test
Name 4 other causes for groin pain in athletes.
- SI joint involvement (referred pain)
- nerve impingement
- inguinal and femoral hernia
- avulsion fracture
What is the Valsalva test?
Valsalva (= nerve)
when coughing / sneezing the abdominal muscles need be engaged - if that is painful then the test is positive. It is used to determine if the groin pain comes from the inguinal area.
What are the examination techniques for a painful tendon?
- observing: skeletal alignment, muscle size, tendon size & swelling
- joint mobility
- muscle strength
- ADL examination
- imaging / echo for establishing neovaschularisation
What condition has the same symptoms as a sports hernia?
Adductor-tendinopathy
What are the risk factors for developing LAGP?
- limited internal rotation of the hip
- pain and weak adductors in adductor squeeze test
- bent knee fall-out
What should be trained in case of adductor-related groin pain?
- adduction + abduction strength
- stabilizing exercisies of hip and pelvis
- m. abdominus transversus
What is the prevalence of male soccer players with groin problems?
10-18%
What is the insertion of the m. piriformis?
trochanter major
What is the origin of the m. pectineus?
os pubis
What is the origin and insertion of the m. gluteus minimus?
origin: fascies glutea
insertion: trochanter major
What are the functions of the m. satorius in the hip?
abduction, external rotation, flexion
what is the origin and insertion of the m. rectus femoris?
origin: SIAI
insertion: tuberositas tibiae
What is the function of the m. adductor magnus?
adduction, external rotation, extension
