Inguinal and pubic related

Question 1

Palpation

Answer 1

Rectus abdominis
Superficial inguinal ring
Inguinal canal
-Maximal tenderness over pubic tubercle
-Dilation or pain on palpation of external inguinal ring
through scrotum

Question 2

Stretch

Answer 2

Passive hip extension in the modified Thomas Test

Question 3

Resist

Answer 3

Oblique sit-up
-Resisted rectus abdominis
Straight sit-up
Hip flexion in the modified Thomas Test

Question 4

Inguinal Related S&S

Answer 4

-Uncommon in females
•Male footballers
•Long hx of gradually worsening groin pain
–Symptoms settle on absence, recur
with return of intensity
•Poorly localised
–Medial groin (pubic tubercle),
scrotum, adductors, lateral thigh

Question 5

Inguinal related Aggs

Answer 5

•Aggs
–activity, especially kicking
–Valsalva manoeuvre
–Sexual activity
–Sneezing/coughing

Question 6

Testing

Answer 6

• Cough Test

- Valsalva manoeuvre? breathe out strongly through your mouth while holding your nose tightly closed.

Question 7

Inguinal/femoral hernia

Answer 7

•Same incidence as general population
•Abdominal contents protrude through weaknesses in abdominal
wall
•Painful on cough, sneeze, valsalva manoeuvre
•Surgical repair
•Cough test
•Femoral hernia - females

Question 8

Pubic Bone related- S&S

Answer 8

Male footballers
− Long long hx of gradually worsening groin pain
− Poorly localised/diffuse
•Kicking, cutting, twisting - recurrent stretching and tearing of the anterior ligaments of the symphysis.
•Ligamentous stretching – symphyseal laxity - lead to impaction of the articular surfaces.
•Bony overload
–Osteitis pubis
–Stress fracture

Question 9

Pubic bone related aggs

Answer 9

− all activities
− easily irritated
− positive adductor findings
− positive crossover sign
− widespread tenderness on palpation

Question 10

Pubic bone testing

Answer 10

Adductor squeeze test

MRI to confirm