1 / 111

“GILMORES GROIN” The First 30 Years. ( plus one ! ) R.S.M. 15 Sept 2011

“GILMORES GROIN” The First 30 Years. ( plus one ! ) R.S.M. 15 Sept 2011. 5% ALL SPORTS INJURIES AFFECT GROIN. PATIENT’S REFERRED with GROIN PAIN 1980 - 2010. TOTAL 7738 MALE 7479 (9 7 %) FEMALE 259 ( 3 %) . INCIDENCE OF OPERATION 1980 - 2010. Referred. Ops. 58% (1% Female).

allen-perez
Download Presentation

“GILMORES GROIN” The First 30 Years. ( plus one ! ) R.S.M. 15 Sept 2011

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. “GILMORES GROIN” The First 30 Years. ( plus one ! ) R.S.M. 15 Sept 2011

  2. 5% ALL SPORTS INJURIES AFFECT GROIN

  3. PATIENT’S REFERRED with GROIN PAIN1980 - 2010 TOTAL 7738 MALE 7479 (97%) FEMALE 259 (3%)

  4. INCIDENCE OF OPERATION1980 - 2010 Referred Ops 58% (1% Female) 7738 pts 4466 pts

  5. OTHER SPORTS • Basketball Fencing • Handball Equestrian • Gaelic football Martial Arts • American Football Dancers • Hurling Gymnasts • Waterpolo Kick Boxing • Ice Hockey Skiing & Snowboarding

  6. DIRECT TRAUMA FALL KICK PUNCH IMPACT SQUEEZE

  7. GILMORE’S GROIN FIRST PATIENT 1980 PATHOLOGY & SURGICAL TREATMENT Apparent after Successful Management of 3 Professional Footballers Unable to Play For over 15 weeks

  8. CASE 1 D.M. 27 FULL BACK: TOTTENHAM HOTSPUR FC PRESENTED: 28.08.80 SYMPTOMS: 17 WEEKS GROIN PAIN AFTER EVERSION INJURY LAST GAME: 17 WEEKS PAIN INCREASED: SPRINTING KICKING TWISTING & TURNING COUGHING SNEEZING

  9. CASE 1 D.M. PHYSICAL SIGNS INSPECTION: N.A.D. –NO SWELLING PALPATION: N.A.D. – NO LUMP NO HERNIA PALPATION VIA SCROTUM: - RIGHT SUPERFICIAL INGUINAL RING DILATED - COUGH IMPULSE - TENDER INSERTION OF FINGER  PAIN COMPARED TO OPPOSITE SIDE

  10. CASE 1 D.M. PREVIOUS INVESTIGATIONS: 3 ORTHOPAEDIC OPINIONS X-RAY CT SCAN U/S SCAN GILMORE: Fourth Opinion PREVIOUS TREATMENT: COMPLETE REST PHYSIOTHERAPY MANIPULATION LOCAL STEROIDS

  11. CASE 2 .G.S Tertiary Opinion MF : ABERDEEN & SCOTLAND PRESENTED: 16.3.81 GROIN PAIN R > L SYMPTOMS: 15 WEEKS : Following Over Stretching Eversion Injury LAST GAME: 15 WEEKS (30.12.80) PAIN  TROTTING SUDDEN MOVEMENT KICKING COUGHING SNEEZING ONLY ABLE TO WALK

  12. CASE 2 – GSPHYSICAL SIGNS INSPECTION: No Swelling PALPATION: No Lump No Hernia PALPATION VIA SCROTUM - DILATED R S.I.R. - READILY ADMITTED FINGER - COUGH IMPULSE - FINGER IN R S.I.R.  TENDERNESS PAIN

  13. My Conclusion after History & Examination Torn Groin Muscles & or Tendons Probably External Oblique Muscle Conjoined Tendon

  14. ACTUAL PATHOLOGYFound at Operation TORN EXTERNAL OBLIQUE ==== DILATED SUPERFICIAL INGUINAL RING TORN CONJOINED TENDON CONJOINED TENDON } DEHISCENCE INGUINAL LIGAMENT

  15. D. M. Post Operatively • Training Fully at 3 weeks • Spurs Team at 5 weeks

  16. Post Operatively Training with Aberdeen 3 wks In Scotland Squad 7 wks

  17. GILMORE’S GROIN GROIN DISRUPTIONSPORTSMEN GROIN(Sportsmen Hernia:Wrongas NO HERNIA )

  18. GROIN DISRUPTION TYPICAL PATIENT • YOUNG MALE • ACTIVE SPORTSMEN • RARE OVER 45 • RARE IN FEMALES (1%)

  19. GROIN DISRUPTION • MUSCULO – TENDINOUS INJURY • ALL LAYERS GROIN • INGUINAL + ADDUCTOR (40%) • “MUSCLE DISLOCATION”

  20. Only 1% Operative Cases Female

  21. GROIN DISRUPTION(GILMORE’S GROIN)31 YEARS 1980 - 2010

  22. PATIENT REFERRAL RELATED TO SPORT1980 - 2010 CASES % ASSOCIATION FOOTBALL 4323 56 RUGBY UNION & LEAGUE 731 9 ATHLETES 372 5 RACQUET GAMES 298 4 CRICKET 175 2 HOCKEY 152 2 OTHER SPORTS 912 12 NO SPORT 775 10 ____________________________________________________ TOTAL 7738 100

  23. OPERATIONS1980 - 2010 TOTAL 4466 MALE 4423 (99%) FEMALE 43 (1%)

  24. INCIDENCE OF OPERATION RELATED TO SPORT1980 - 2010 CASESOPN % ASSOCIATION FOOTBALL ** 4323 2981 69 RUGBY UNION + LEAGUE ** 731 468 64 CRICKET** 175 118 68 ATHLETES 372 151 39 RACQUET GAMES 298 101 34 HOCKEY 152 88 58 OTHER SPORTS 912 307 34 NO SPORT 775 252 32 __________________________________________________________ TOTAL 7738 4466 58

  25. INCIDENCE OF OPERATIONS ASSOCIATION FOOTBALL 1980 - 2010 TOTALOPN % PROFESSIONAL 1546 1275 82 SEMI PRO. 755 538 71 AMATEUR 2022 1168 57 _______________________________________________ TOTAL 4323 2981 69

  26. PROFESSIONAL FOOTBALLERS1980 - 2010 CASES 1546 OPERATIONS 1275 (82%)

  27. ENGLISH FOOTBALL LEAGUECLUBS 92 CLUBS PATIENTS REFERRED BY 91

  28. AETIOLOGY:MUSCLE IMBALANCE( Recurrent Microtrauma ) 1. STRONG HIP FLEXORS PULL PELVIS DOWN (QUADS) • TILTED PELVIS STRETCH ABDO MUSCLES 3. STRETCHED ABDO MUSCLES BECOME WEAK (OBLIQUES) FAIL TO STABILIZE PELVIS 4. OVERUSE RECURRENT TEARS GROIN DISRUPTION 5. MALE > FEMALE (99%)

  29. ARSENAL F.C.: GILMORE’S GROIN OPERATION P.A. 1986 – 1996 (GRAHAM) 33 3 1997 – 2007 (WENGER) 10 1 Gary Lewin 2007

  30. ONSET OF SYMPTOMS INSIDIOUS 72% SPECIFIC INJURY 28% OVERSTRETCHING MISKICKING ABDUCTION EVERSION

  31. SYMPTOMS DURING EXERCISE PAIN IN GROIN INCREASES WITH RUNNING STRIDING SPRINTING SUDDEN MOVEMENT TWISTING & TURNING SIDE STEPPING JUMPING DEAD BALL KICKING LONG BALL KICKING

  32. SYMPTOMS AFTER EXERCISE STIFF & SORE PAIN IN GROIN INCREASES WITH TURNING IN BED GETTING OUT OF BED GETTING OUT OF CAR SIT UPS COUGHING SNEEZING SUDDEN MOVEMENT

  33. EXAMINATION

  34. GROIN DISRUPTION: PHYSICAL SIGNS (ALL ELICITED VIA SCROTUM) S.I.R: DILATED (+/-) COUGH IMPULSE TENDER (PALPABLE TEAR) TENDERNESS: MAY BE EXQUISITE DIMINISHES WITH REST

  35. INVESTIGATIONS

  36. STORK VIEWS(FLAMINGO)

  37. MRI in Groin Disruption MRI Poor in Abdomen Resolution insufficient for subtle changes But Inguinal ligament – clearly visible Gaps Defects Significant Disruption Gross Scar Tissue MRI Good in Pelvis & Thigh Osteitis pubis HIP Pathology Adductor Tears Also visible clearly seen David Connell 2009

  38. Ultrasound in Groin Disruption State of Art Ultrasound Equipment – required Subtle changes in Inguinal ligament Conjoined Tendon Dynamic assessment – Essential Abdominal straining Sonopalpation Tender over Inguinal Canal Bulging Post. Wall maybe seen David Connell 2009

  39. INDICATIONS FOR SURGERY PROFESSIONAL AND AMATEUR FAILED CONSERVATIVE TREATMENT

  40. INDICATION FOR SURGERY: PROFESSIONALS GAME INHIBITED TRAINING INHIBITED  LOSS OF SPEED LOSS OF FITNESS

More Related