Groin pain

Question 1

What are 4 risk factors for tendinopathy?

Answer 1

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

Question 2

Why does the Achilles tendon not have a tendinitis

(generally)?

Answer 2

• no inflammatory cells in Achilles tendon

it has ingrowth of blood vessels, more innervation, glutamate which makes it painful

Question 3

Explain the stages of tendinopathy.

Answer 3

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.

Question 4

When does the collagen synthesis and collagen degradation balance out in a tendon after sports?

Answer 4

After 36 hours

Question 5

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

Answer 5

Reactive tendinopathy

Question 6

Nelson was in the stage of tendon disrepair in the Model of Cook & Purdam. What does he have to do to recover?

Answer 6

Take rest, stop training and slowly increase load when exercising again.

Question 7

What do you focus on if the patient is in the degenerative tendinopathy phase in your treatment?

Answer 7

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.

Question 8

What does the Iceberg model by Fredberg represent for tendinopathy?
(why is a tendinopathy also called iceberg tendinopathy?)

Answer 8

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.

Question 9

What are characteristics for the Cam-type impingement and the Pincer-type impingement?

Answer 9

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

Question 10

Which incidence has Cam- morphology?

Answer 10

• 25% in non-athletes

- 66% in athletes

Question 11

What does FAI stand for?

Answer 11

Femoro-acetabular impingement

Question 12

What are symptoms of FAI?

Answer 12

• ROM adduction & internal rotation limitation
• muscle strength reduction
• catching, giving way, locking
• prolonged sitting/ periods of flexion causes pain

Question 13

´Which 2 diagnostic test can you think of to test FAI?

Answer 13

• FADDIR

* FABER

Question 14

Is the FADDIR test an exclusion or inclusion test?

Answer 14

exclusion test, due to 99% sensitivity
Snout rule (high sensitivity --> rules out)

Question 15

What is the agreement called which defines groin pain?

Answer 15

The Doha agreement

Question 16

Name 3 symptoms of inguinal-related groin pain.

Answer 16

	Inguinal tenderness
	Pain in inguinal canal region
	No palpatable hernia
	Pain aggravated by resistance test for abdominal muscles
(Valsalva (nerve) cough- sneeze test)

Question 17

What does LAGP stand for?

Answer 17

Long-standing adductor-realted groin pain

Question 18

What does the abbreviation ‘FABER’ stand for?

Answer 18

FABER = flexion, abduction, external rotation test

Question 19

Name 4 other causes for groin pain in athletes.

Answer 19

• SI joint involvement (referred pain)
• nerve impingement
• inguinal and femoral hernia
• avulsion fracture

Question 20

What is the Valsalva test?

Answer 20

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.

Question 21

What are the examination techniques for a painful tendon?

Answer 21

• observing: skeletal alignment, muscle size, tendon size & swelling
• joint mobility
• muscle strength
• ADL examination
• imaging / echo for establishing neovaschularisation

Question 22

What condition has the same symptoms as a sports hernia?

Answer 22

Adductor-tendinopathy

Question 23

What are the risk factors for developing LAGP?

Answer 23

• limited internal rotation of the hip
• pain and weak adductors in adductor squeeze test
• bent knee fall-out

Question 24

What should be trained in case of adductor-related groin pain?

Answer 24

• adduction + abduction strength
• stabilizing exercisies of hip and pelvis
• m. abdominus transversus

Question 25

What is the prevalence of male soccer players with groin problems?

Answer 25

10-18%

Question 26

What is the insertion of the m. piriformis?

Answer 26

trochanter major

Question 27

What is the origin of the m. pectineus?

Answer 27

os pubis

Question 28

What is the origin and insertion of the m. gluteus minimus?

Answer 28

origin: fascies glutea
insertion: trochanter major

Question 29

What are the functions of the m. satorius in the hip?

Answer 29

abduction, external rotation, flexion

Question 30

what is the origin and insertion of the m. rectus femoris?

Answer 30

origin: SIAI
insertion: tuberositas tibiae

Question 31

What is the function of the m. adductor magnus?

Answer 31

adduction, external rotation, extension