Pelvic Pain And Regenerative Therapies Flashcards
What forms the pubic aponeurosis
- rectus abdominus
- conjoint tendon (internal oblique and transverse abdominus)
- external oblique
What is the purpose of the pubic symphysis
Acts as a fulcrum for anterior pelvis
- hyper mobility of this joint may occur in postpartum women
What is the most common hernia
Inguinal hernia
What is an inguinal hernia
- abdominal tissue pushes through an opening in the lower abdominal wall
Where does inguinal hernia occurs
Inguinal canal
What is an umbilical hernia
Occurs at the umbilicus when a loop of intestine pushes though the umbilical ring
What is a sports hernia aka athletic pubalgia?
Straining or tearing of any tissue in the lower abdomen or groin that also connects to part of the adductors
- most often nothing actually herniates
Where do sports hernia often occur
Near where the abdominals and adductors attach at the pubic bone
What are the symptoms of sports hernia
Activity related lower abdominal and proximal adductor related pain
MOI for sports hernia
- hard sudden planting of the foot with a twisting rotation of the body and a rapid intense level
- hyperextension of pelvis with thigh hyper abduction
- cutting and pivoting motions
- kicking mechanism
- swinging bat mechanism
What are some physical exams for sports hernia
- palpation of sites of injury at pubic tubercle, pubic symphysis, hip evaluation
- pain with resisted thigh addiction
What are the special tests for sports hernia
- resisted sit-up or crunch with palpation of the inferolateral edge of the distal recuts abdominus may re-create symptoms
- valsalva maneuvers
What is osteitis pubis?
Painful chronic overuse condition affecting the pubic symphysis and surrounding soft tissues
- chronic mucrotrauma
What are the symptoms of osteitis pubis
Pelvic pain and local tenderness over the pubic symphysis
What are the main 2 sports where osteitis pubis is most common
Kicking (soccer players)
Distance running
What are the two main etiologies of osteitis pubis?
- muscle imbalance between the abdominal and hip adductor muscles - most often discusses
- reduced internal rotation of the hip and instability of the sacroiliac joint
What is the preferred imaging for osteitis pubis?
MRI
What is seen on x-ray for osteitis pubis?
symphyseal bony sclerosis, erosions and widening or narrowing of the joint in chronic/severe phase
What is regenerative medicine
Biological treatments to improve symptoms of certain orthopedic conditions and has the potential to enhance healing in musculoskeletal tissues
What is the purpose of regenerative medicine
- help shorten and improve healing process
- stimulate body’s own healing process
What are the steps in platelet rich plasma
- Collecting blood
- separating the platelets
- platelet-rich plasma extraction from test tube
- return of PRP to the patient
What are the actions of PRP
- coagulation and hemostasis
- angiogenesis
- pro inflammatory and anti-inflammator
- cell- biological behaviors
- delivery vehicles
What is the purpose of stem cell injection
- help regenerate and repair tissues
- embryonic stem cells can be guided into becoming specific cells
What is the most common stem cells used in orthopedics
Autologous mesenchymal stem cells
What is prolotherpy
Introduces small amounts of an irritant solution to the site of painful and degenerated tendon to promote growth of normal cells and tissues
What does prolotherapy most often contains
Dextrose (d-glucose)
How does prolotherapy work
Using an irritating stimulus to reactivate the body’s natural healing response - initiates he local inflammatory cascade, which triggers the release of growth factors and collagen deposition
What are the phases in tissue repair
- bleeding
- inflammation
- proliferation
- remodeling
What does amniotic injections contain
Multi potent stem cells and factors that promote tissue healing: collagen, fibroblasts and growth factors, amniotic membrane-human mesenchymal stromal cells
What is shockwave?
Ballistically generated waves to transform kinetic energy to expanding waves which is believed to cause an interstitial and extra cellular response with acoustic signals contributing to a biological cascade
What is the MOA for shockwave
- inhibits substance P and disrupts pain cycle
- causes interstitial and extra cellular responses leading to tissue regeneration
What are the features of radial shockwave
- ultrasonic pulses
- greatest energy at the tip of the probe
- better for fascia, tendon, ligament
What are the features of focused shockwave
- increased treatment depth and precision
- better for deeper or boney application
- typically better reported patient comfort during treatment
