medial groin and hernia: sonographic evaluation adam m ... conference... · • spigelian hernia...
TRANSCRIPT
Objectives
• Understand anatomy of medial hip and hernias
• Go over inguinal, direct, indirect, Spigelian, and “sports
hernia”
• Scanning protocols for each
Ways to illicit a Hernia
• 1. Bearing down(Valsalva)
– Try blowing on back of hand
• 2. Lifting shoulders
• 3. Bearing down while lifting shoulders
• 4. Coughing
• 5. Standing Evaluation
Femoral Triangle Anatomy
• Femoral Canal
– Femoral artery and vein
– Femoral Br.
Genitofemoral nrv
– lymph nodes
– Femoral nerve is
separate
• More common in
females
– Common post-pardum
Inguinal Canal Anatomy
• Deep and superficial rings
• Females
– Round ligament of Uterus
• Males
– Spermatic cord
– Testicular artery and vein
– Artery to Vas Deferens
– Pampiniform Plexus
– Genital br. Genitofemoral
Nrv
– Vas deferens
– Lymph
– Processus Vaginalis
– Autonomic nerves
Spigelian Hernia
• Spigelian hernia (1-2% of all hernias) is the protrusion of
preperitoneal fat, peritoneal sac, or organ(s) through a congenital
or acquired defect in the spigelian aponeurosis
– the aponeurosis of the transverse abdominal muscle limited by
the linea semilunaris laterally and the lateral edge of the rectus
muscle medially
Skandalakis, PN. Et al. 2006
“Sports Hernia” / Athletic Pubalgia
• Its not athletic pubalgia
• Its not osteitis pubis/ pubic instability
• Its not adductor/gracillis tendinopathy
• Its not rectus abdominus or conjoint
tendinopathy
• Its not a hernia
• It is tranversalis diastasis with deformation
of the spermatic cord or round ligament
Scanning for “Sports Hernia”
• Pubic symphysis
• Adductor tendons
– Esp adductor longus
• Gracilis
• Rectus abdominus
aponeurosis/tendon
• Conjoint tendon
• Direct region
– Laxity of transversalis
fascia-Valsalva
References
• The Athletic Hernia-A Systemic Review; Swan and Wolcott:Clinical Orthopaedics and Related
Research; 2006 455:78-87
• Sportsmen’s Groin-Diagnostic Approach and Treatment With the Minimal Repair Technique: A
Single-Center Uncontrolled Clinical Review; Muschaweck /Berger: Sports Health 2010 2:216-
220
• Santilli, O. L., et al. (2015). "Sports hernias: experience in a sports medicine center."Hernia.
• Steele, P., et al. (2004). "Surgery for posterior inguinal wall deficiency in athletes." J Sci Med
Sport 7(4): 415-421; discussion 422-413.
• Orchard, J. W., et al. (1998). "Groin pain associated with ultrasound finding of inguinal canal
posterior wall deficiency in Australian Rules footballers." Br J Sports Med 32(2):134-139.
• Hackney, R. G. (1993). "The sports hernia: a cause of chronic groin pain." Br J Sports Med
27(1): 58-62.
• Obey MR1, Broski SM2, Spinner RJ3, Collins MS2, Krych AJ4. Anatomy of the Adductor
Magnus Origin: Implications for Proximal Hamstring Injuries. Orthop J Sports Med. 2016
Jan 11;4(1):2325967115625055. doi: 10.1177/2325967115625055. eCollection 2016 Jan.