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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Primary synovial chondromatosis is a rare disorder that can present as chronic hip and groin pain. It is characterized by formation of osteocartilaginous nodules arising from the synovium. We report the first case, to our knowledge, of an Olympic-caliber cyclist, in her mid thirties, with primary synovial chondromatosis of the left hip. Clinical examination showed decreased internal rotation, external rotation, forward flexion, and abduction of the left hip. A radiograph of the left hip showed slight hip-joint narrowing centrally. A magnetic resonance imaging arthrogram showed a small anterior labral tear and innumerable small intermediate-intensity filling defects situated diffusely within the joint fluid. Fluoroscopically guided injection of the left hip with local anesthetic and cortisone produced temporary pain relief. Conservative treatment was marginally helpful. Results of a rheumatology workup were unremarkable. Arthroscopic removal of loose bodies and synovectomy were performed. The diagnosis of primary synovial chondromatosis was confirmed by histologic examination. At the 17-month follow-up, our patient was essentially pain free and had returned to her previous athletic activities.
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PMID:Synovial chondromatosis in an elite cyclist: a case report. 1673 Dec 23

Hip hemiarthroplasty is performed routinely on patients with tumors of the proximal femur, although the long-term effect on the native acetabulum is unknown. We measured the amount of femoral head migration that would occur with intermediate and long-term followup. We also measured the amount of groin pain experienced by patients with longer followup and the overall rate of conversion to total hip arthroplasty. From a surgical database, we identified 442 patients with tumors who had 447 hip hemiarthroplasties without or with an allograft composite. We reviewed the medical records and radiographs of 32 patients with at least 5 years followup (median followup, 10 years) to determine their clinical and radiographic outcomes. The median proximal and medial migration measurements were 3 mm (range, 0-24 mm) and 2 mm (range 0-20 mm), respectively. Thirty-one patients had minimal or no groin pain. Seven of the 447 arthroplasties (1.6%) were converted to total hip arthroplasties. Even patients with long-term followup usually had minimal pain and radiographic changes. The overall rate of conversion to total hip arthroplasty was low. Concern regarding excessive acetabular wear resulting in conversion to total hip arthroplasty in patients with tumors is not supported by our data.
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PMID:Acetabular outcome after hip hemiarthroplasty in patients with tumors. 1711 57

The athletic hernia is an obscure condition of uncertain etiology commonly seen in soccer and rugby players. The pain is often debilitating and may place an athletic career at risk. Treatment failures are frustrating to the athlete and the physician. The anatomy involved, diagnostic criteria, and treatment modalities are inconsistently described in the medical, surgical and orthopaedic literature. There is no evidence-based consensus available to guide decision-making. We performed an overview of the anatomy and pathoanatomy and a systematic review of the literature to gain insight into the disease and its treatment. Most studies are Level IV. The most common operative finding is a deficient posterior wall of the inguinal canal, although other abdominal wall abnormalities are frequently found. Open and laparoscopic repairs produce excellent results, but the latter allows earlier return to play. Magnetic resonance imaging appears to have excellent diagnostic potential for athletic hernia. A multidisciplinary approach to groin pain in the athlete is recommended.
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PMID:The athletic hernia: a systematic review. 1714 62

The causes of pain after total hip arthroplasty are multiple. We present a series of 15 patients (16 cases) who presented with pain related to the iliopsoas tendon. All patients had previously undergone cementless hip arthroplasty and presented with similar symptoms and clinical signs. Surgery was carried out after failure of conservative measures. Release of the iliopsoas tendon from the lesser trochanter gave good symptomatic relief in all except one patient who required reposition of acetabular prosthesis, with the average Harris Hip Score improving from 58 (range, 44-70) to 91 (range, 78-95) postoperatively. This relatively uncommon condition should be considered in the differential diagnosis of all patients who present with groin pain after total hip arthroplasty. Surgical release of the iliopsoas tendon can give excellent results in these patients.
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PMID:Iliopsoas tendonitis a complication after total hip arthroplasty. 1727 28

Anterior femoroacetabular impingement is a mechanical hip disorder defined as abnormal contact between the anterior acetabular rim and the proximal femur. The typical patient is a young man who practices a martial art that involves kicking. Mechanical groin pain is the main presenting symptom. Passive flexion and internal rotation of the hip replicates the pain. The range of internal rotation is often limited. Imaging studies show a non-spherical femoral head or overhang of the anterior acetabular rim. Computed arthrotomography or magnetic resonance arthrography visualize focal damage to the anterosuperior labrum and sometimes to the acetabular cartilage. Discontinuing the activity associated with the harmful hip movement is the main treatment. However, arthroplasty and removal of damaged labral tissue may be required. Surgical outcomes correlate negatively with the severity of the cartilage lesions.
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PMID:Anterior femoroacetabular impingement. 1733 28

Sportsman's hernia (SH) is a controversial cause of chronic groin pain in athletes. Most commonly seen in soccer and ice hockey players, SH can be encountered in a variety of sports and in a variety of age groups. Although there are several reports of SH in women, it is almost exclusively found in men. SH is largely a clinical diagnosis of exclusion. History of chronic groin pain that is nonresponsive to treatment should raise suspicion of SH, but physical examination findings are subtle and most diagnostic tests do not definitively confirm the diagnosis. Conservative treatment of SH does not often result in resolution of symptoms. Surgical intervention results in pain-free return of full activities in a majority of cases.
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PMID:Sportsman's hernia. 1737 39

Prolonged groin pain after transobturator tape is uncommon. Three women reported groin pain that had not improved by 3 months postoperatively. Combined steroid and local anesthetic was effective for pain relief in all patients. The differential diagnosis of persistent groin pain after transobturator tape includes adductor muscle strain, osteitis pubis, obturator/groin abscess, structural adhesions, and inflammation, edema or nerve entrapment of the anterior branch of the obturator nerve. No side effects of treatment were noted. Patients that do not respond to local injection may require mesh dissection and excision.
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PMID:Management of persistent groin pain after transobturator slings. 1743 34

Ilioinguinal nerve entrapment presents with a clinical triad of pain in the iliac fossa and inguinal region, sensory abnormalities in the cutaneous distribution of the nerve and tenderness on palpation 2-3 cm medial and below the anterior superior iliac spine. The syndrome poses diagnostic difficulties, as genitofemoral nerve entrapment and non-neurological conditions of the lower abdomen may cause similar pain. We report on a patient with acute groin pain radiating towards the scrotum, caused by ilioinguinal nerve entrapment. The clinical diagnosis was strongly suggested by electromyographic examination, using the monopolar needle as a deep stimulating electrode. Subsequent nerve blockade caused complete relief of symptoms. The technique is described. Future applications for treatment of post-surgical pain are discussed.
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PMID:Acute scrotal pain from idiopathic ilioinguinal neuropathy: diagnosis and treatment with EMG-guided nerve block. 1748 7

The purpose of this study was to identify subjective complaints and objective findings in patients treated for femoroacetabular impingement (FAI). Three hundred and one arthroscopic hip surgeries were performed to treat FAI. The most frequent presenting complaint was pain, with 85% of patients reporting moderate or marked pain. The most common location of pain was the groin (81%). The average modified Harris Hip score was 58.5 (range 14-100). The average sports hip outcome score was 44.0 (range 0-100). The anterior impingement test was positive in 99% of the patients. Range of motion was reduced in the injured hip. Patients who had degenerative changes in the hip had a greater reduction in range of motion. The most common symptom reported in patients with FAI was groin pain. Patient showed decreased ability to perform activities of daily living and sports. Significant decreases in hip motion were observed in operative hips compared to non-operative hips.
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PMID:Clinical presentation of femoroacetabular impingement. 1749 26

Pelvic apophyseal injuries typically involve adolescents, ranging gradually from apophysitis as a chronic traction injury to avulsion fractures after a sudden contraction of a muscle to the immature musculo-skeleton adolescent. While avulsion fractures to the anterior superior iliac spine, the iliac crest and the pubic bone are common, injuries to the anterior inferior iliac spine (AIIS) are only rarely encountered. We report on two 42 and 43-year old male soccer players complaining of groin pain. Both had AIIS avulsion fractures diagnosed by conventional plain x-ray of the pelvis, ultrasound and magnetic resonance imaging. One patient had an acute adductor longus muscle injury with concomitant asymptomatic AIIS avulsion fracture. Conservative treatment of the muscle injury with initial RICE therapy followed by pain-restricted jogging brought him back to sport within four weeks. The other patient had local tenderness and exercise pain at AIIS with a large exostosis on imaging studies mimicking a pseudotumor. Surgical resection was applied and the rectus femoris muscle was reattached. After three months of intensive physical therapy he could be return to sport. Avulsion fractures of the AIIS may cause persistent pain syndrome and mimic a pseudotumor decades after the initial trauma, which can be treated by surgical resection and reattachment of the rectus femoris muscle with good results. Conservative treatment for minor dislocated AIIS avulsion fractures can be effective in sportsmen. Differential diagnosis often involves bony tumors, so patient's soccer history gives important information regarding past avulsion fractures of the pelvis, which often occur during kicking in the adolescence.
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PMID:[Avulsion injuries of the anterior inferior iliac spine among soccer players--a differential diagnosis to neoplasm decades following the trauma]. 1789 32


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