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“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).

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

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  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

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