Pelvic Pain And Regenerative Therapies

Question 1

What forms the pubic aponeurosis

Answer 1

• rectus abdominus
• conjoint tendon (internal oblique and transverse abdominus)
• external oblique

Question 2

What is the purpose of the pubic symphysis

Answer 2

Acts as a fulcrum for anterior pelvis
- hyper mobility of this joint may occur in postpartum women

Question 3

What is the most common hernia

Answer 3

Inguinal hernia

Question 4

What is an inguinal hernia

Answer 4

• abdominal tissue pushes through an opening in the lower abdominal wall

Question 5

Where does inguinal hernia occurs

Answer 5

Inguinal canal

Question 6

What is an umbilical hernia

Answer 6

Occurs at the umbilicus when a loop of intestine pushes though the umbilical ring

Question 7

What is a sports hernia aka athletic pubalgia?

Answer 7

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

Question 8

Where do sports hernia often occur

Answer 8

Near where the abdominals and adductors attach at the pubic bone

Question 9

What are the symptoms of sports hernia

Answer 9

Activity related lower abdominal and proximal adductor related pain

Question 10

MOI for sports hernia

Answer 10

• 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

Question 11

What are some physical exams for sports hernia

Answer 11

• palpation of sites of injury at pubic tubercle, pubic symphysis, hip evaluation
• pain with resisted thigh addiction

Question 12

What are the special tests for sports hernia

Answer 12

• resisted sit-up or crunch with palpation of the inferolateral edge of the distal recuts abdominus may re-create symptoms
• valsalva maneuvers

Question 13

What is osteitis pubis?

Answer 13

Painful chronic overuse condition affecting the pubic symphysis and surrounding soft tissues
- chronic mucrotrauma

Question 14

What are the symptoms of osteitis pubis

Answer 14

Pelvic pain and local tenderness over the pubic symphysis

Question 15

What are the main 2 sports where osteitis pubis is most common

Answer 15

Kicking (soccer players)
Distance running

Question 16

What are the two main etiologies of osteitis pubis?

Answer 16

• muscle imbalance between the abdominal and hip adductor muscles - most often discusses
• reduced internal rotation of the hip and instability of the sacroiliac joint

Question 17

What is the preferred imaging for osteitis pubis?

Answer 17

MRI

Question 18

What is seen on x-ray for osteitis pubis?

Answer 18

symphyseal bony sclerosis, erosions and widening or narrowing of the joint in chronic/severe phase

Question 19

What is regenerative medicine

Answer 19

Biological treatments to improve symptoms of certain orthopedic conditions and has the potential to enhance healing in musculoskeletal tissues

Question 20

What is the purpose of regenerative medicine

Answer 20

• help shorten and improve healing process
• stimulate body’s own healing process

Question 21

What are the steps in platelet rich plasma

Answer 21

• Collecting blood
• separating the platelets
• platelet-rich plasma extraction from test tube
• return of PRP to the patient

Question 22

What are the actions of PRP

Answer 22

• coagulation and hemostasis
• angiogenesis
• pro inflammatory and anti-inflammator
• cell- biological behaviors
• delivery vehicles

Question 23

What is the purpose of stem cell injection

Answer 23

• help regenerate and repair tissues
• embryonic stem cells can be guided into becoming specific cells

Question 24

What is the most common stem cells used in orthopedics

Answer 24

Autologous mesenchymal stem cells

Question 25

What is prolotherpy

Answer 25

Introduces small amounts of an irritant solution to the site of painful and degenerated tendon to promote growth of normal cells and tissues

Question 26

What does prolotherapy most often contains

Answer 26

Dextrose (d-glucose)

Question 27

How does prolotherapy work

Answer 27

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

Question 28

What are the phases in tissue repair

Answer 28

• bleeding
• inflammation
• proliferation
• remodeling

Question 29

What does amniotic injections contain

Answer 29

Multi potent stem cells and factors that promote tissue healing: collagen, fibroblasts and growth factors, amniotic membrane-human mesenchymal stromal cells

Question 30

What is shockwave?

Answer 30

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

Question 31

What is the MOA for shockwave

Answer 31

• inhibits substance P and disrupts pain cycle
• causes interstitial and extra cellular responses leading to tissue regeneration

Question 32

What are the features of radial shockwave

Answer 32

• ultrasonic pulses
• greatest energy at the tip of the probe
• better for fascia, tendon, ligament

Question 33

What are the features of focused shockwave

Answer 33

• increased treatment depth and precision
• better for deeper or boney application
• typically better reported patient comfort during treatment