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“Sportershernia/plaatsen matje”

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Presentation on theme: "“Sportershernia/plaatsen matje”"— Presentation transcript:

1 “Sportershernia/plaatsen matje”
Prof. dr. C.H.J. van Eijck Afd. Heelkunde

2 Chirurg

3 Clubarts

4

5 Sportsman’s hernia

6

7 Sportsman’s hernia Chronic groin pain Differential diagnosis
Incidence: 6% 60% during active soccer carier 50% > 20 weeks complaints Differential diagnosis

8 Differential diagnosis Groin injury
Muscle and tendon injury Tendon-bone or tendon-muscle Avulsion fracture Adductor longus, rectus femoris or abdominis X-Pelvis, bone scan, ultrasound or MRI

9 Differential diagnosis Groin injury
Osteïtis pubis Painfull symfysis and adductor-tenoperiostitis Direct trauma Pelvic instability/Sacroiliacal abnormalities 25% Radiologic abnormalities X-Pelvis, bone scan, ultrasound or MRI

10 Osteïtis pubis

11 Osteïtis pubis

12 Differential diagnosis Groin injury
Stressfracture Ramus inferior os pubis (5%) Collum femoris avascular necrosis Femur head X-Pelvis, bone scan, (MRI)

13 Differential diagnosis Groin injury
Urologic diseae Prostatitis Epididymitis Urethritis Hydrocèle testis Non-descending testicle Rectal toucher, bact. culture, ultrasound

14 Differential diagnosis Groin injury
Hip en Spine disease Osteochondritis lumbal verterbra M. Scheuermann Discus pathology., L1 en L2 Cam type femoroacetabular impingement Congenital hipdysplasia Epifysiolysis femur headkop Avascular necrosis femur head X-LWK (+3/4), X-femur (Faux-profile), bone scan and CT-scan (arthography)

15 Differential diagnosis Groin injury
Nerve entrapment/previous surgery N. ilio-inguinalis (symfysis) N. genitofemoralis (testicle)

16 Differential diagnosis Groin injury
Nerve entrapment/previous surgery N. ilio-inguinalis (symfysis) N. genitofemoralis (testicle) N. obturatorius (med. thigh and adductor weakness) Proof blockade and/or EMG

17 N. obturatorius (med. thigh and adductor weakness)
Nerve entrapment N. obturatorius (med. thigh and adductor weakness)

18 Physical examination Groin injury
Renee Dannenburg

19 Physical examination Groin injury
Lower back, SI Joint and hip Abdominal muscles Muscles of the upper legs Rectal toucher Palp funiculus and testicles 19

20 Physical examination Groin injury
Lower back, SI Joint and hip Abdominal muscles Muscles of the upper legs Rectal exam., palp funiculus and testicles Painfull int. and ext. annulus with elevated intra-abdominal pressure Painfull int. and ext. annulus with elevated intra-abdominal pressure

21 Sportsman’s hernia Weakness of the post. inguinal wall
Symptomatic non-palpable hernia Disruption of the ext. obl. aponeurosis Pubalgy

22 Complaints Long existing groin pain Pain around the external annulus
Combination with adductor-tendopathy Good reaction on NSAID’s Increased pain with elevated intra-abdominal pressure

23 Pathofysiology Sportsman’s hernia
Post wall inguinal canal: fascia transversalis No striated muscle fibers Funiculus through the int. annulus

24 Pathofysiology Sportsman’s hernia

25 Pathofysiology Sportsman’s hernia
Post wall inguinal canal: fascia transversalis No striated muscle fibers Funiculus through the int. annulus Weakness post. wall Lat. Hernia Tension peritoneum Nerve entrapment

26 Treatment Sportsman’s hernia
Conservative Rest, Fysiotherapy and NSAID’s Renee Dannenburg

27 Treatment Sportsman’s hernia
Conservative Rest, Fysiotherapy and NSAID’s Operative Strengthening of the post. Wall of the inguinal canal Conventional (Lichtenstein-plastiek) Laparoscopic 27

28 Patients Sportsman’s hernia
Since 1998 till present: n=240 (Semi)professional n=98 (4 women) 76 soccer, 4 atletics , 3 tennis, 4 cycling, 11 misc. Amateur n=142 (3 women) 127 soccer, 15 misc.

29 Patients Sportsman’s hernia
Mean Age: 25 ± 4.5 year (17-36) Time complaints: 3 months till >2 years

30 Diagnostics Sportsman’s hernia
Herniografie (n=7) High false-negative percentage Ultrasonography (n=167) X-pelvic and femur (n=68) Bone scan (n=53) CT-scan (n=22) MRI (n=57) Laparoscopy (n=1)

31 Indirect H .inguinalis 1 2

32 Patients Sportsman’s hernia
Open Lichtenstein n=3 Laparoscopic TEP n=237 Tenotomy n=12 Left n=86 Right n=89 Both n=65

33 Total Extra Perinoneal (TEP)

34 Total Extra Perinoneal (TEP)

35 Total Extra Perinoneal (TEP)

36 Laparoscopy TEP right

37 Total Extra Perinoneal (TEP)

38 Laparoscopy

39 Laparoscopy

40 Laparoscopy

41 Total Extra Perinoneal (TEP)

42

43 Total Extra Perinoneal (TEP)

44 Peroperative findings Sportsman’s hernia
(Min.) lateral hernia n=65 (Min.) medial hernia n=24 Preperitoneal lipoma n=39 Enlarged lymph nodes n=32 No abnormallities n=80

45 Complications Sportsman’s hernia
Sup. woundinfection (S.aureus) (n=4) Adductor longus tendinopathy (n=14)  tenotomie (n=4) Mesh irritation/seroma (Prolene®) (n=12) Mesh displacement ( n=4) Giant cell tumor re prox. femur (n=1) Sports recovery

46 Sportsman’s hernia Renee Dannenburg Time Revalidation Week 0 - 1

47 Sportsman’s hernia Time Purpose Therapy Week 0 - 1 Wound recovery
Pain management Walking 5 km/h Week Optimizing scar tissue Preventing muscle atrophia Aqua training Power walking Cycle ergometer Isometric training Rect. Abd. Steps Week 2 - 3 Dynamic training Rect. Abd. Functional exercise Sit-ups Running Lunges Week 3 - 5 Sport specific training Weight training Normal training Week 6 47

48 Sportsman’s hernia

49 Sportsman’s hernia Recovery Without tenotomy: 4-8 weeks
With tenotomy: weeks

50 The TEP is an efficient method for the treatment of patients with a
Conclusion The TEP is an efficient method for the treatment of patients with a Sportsman’s hernia

51 Dank voor jullie aandacht en veel succes verder


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