“GILMORES GROIN”

The First 30 Years.

( plus one ! )

R.S.M. 15 Sept 2011

5% ALL SPORTS INJURIES 5% ALL SPORTS INJURIES

AFFECT GROINAFFECT GROIN

PATIENT’S REFERRED with PATIENT’S REFERRED with GROIN PAINGROIN PAIN

1980 - 20101980 - 2010

TOTALTOTAL 77387738

MALEMALE 74797479 (9(977%)%)

FEMALEFEMALE 259259 ((33%)%)

INCIDENCE OF OPERATIONINCIDENCE OF OPERATION1980 - 20101980 - 2010

Referred

7738 pts

Ops

4466 pts

58%

(1% Female)

OTHER SPORTS

Basketball Fencing

Handball Equestrian

Gaelic football Martial Arts

American Football Dancers

Hurling Gymnasts

Waterpolo Kick Boxing

Ice Hockey Skiing & Snowboarding

GROIN PAINGROIN PAIN

•• MANY CAUSESMANY CAUSES

•• ORTHOPAEDICORTHOPAEDIC

•• SOFT TISSUE INJURYSOFT TISSUE INJURY

•• COCO--EXISTENT PATHOLOGYEXISTENT PATHOLOGY

DIRECT TRAUMADIRECT TRAUMA

FALLFALL

KICKKICK

PUNCHPUNCH

IMPACTIMPACT

SQUEEZESQUEEZE

GILMORE’S GROIN GILMORE’S GROIN

FIRST PATIENTFIRST PATIENT

19801980

PATHOLOGY & SURGICAL TREATMENTPATHOLOGY & SURGICAL TREATMENT

Apparent after Successful ManagementApparent after Successful Management

ofof

3 Professional Footballers Unable to Play3 Professional Footballers Unable to Play

For over 15 weeksFor over 15 weeks

CASE 1CASE 1 D.M. 27D.M. 27

FULL BACK:FULL BACK: TOTTENHAM HOTSPUR FCTOTTENHAM HOTSPUR FC

PRESENTED:PRESENTED: 28.08.8028.08.80

SYMPTOMS:SYMPTOMS: 17 WEEKS GROIN PAIN17 WEEKS GROIN PAIN

AFTER EVERSION INJURYAFTER EVERSION INJURY

LAST GAME:LAST GAME: 17 WEEKS17 WEEKS

PAIN INCREASED:PAIN INCREASED: SPRINTINGSPRINTING

KICKINGKICKINGTWISTING & TURNINGTWISTING & TURNINGCOUGHINGCOUGHINGSNEEZINGSNEEZING

CASE 1 D.M. PHYSICAL SIGNSCASE 1 D.M. PHYSICAL SIGNS

INSPECTION:INSPECTION: N.A.D. –NO SWELLINGN.A.D. –NO SWELLING

PALPATION:PALPATION: N.A.D. – NO LUMP NO HERNIAN.A.D. – NO LUMP NO HERNIA

PALPATION VIA SCROTUM:PALPATION VIA SCROTUM:-- RIGHT SUPERFICIAL INGUINAL RIGHT SUPERFICIAL INGUINAL

RING DILATEDRING DILATED

-- COUGH IMPULSECOUGH IMPULSE

-- TENDERTENDER

INSERTION OF FINGER PAIN COMPARED TO OPPOSITE SIDEINSERTION OF FINGER PAIN COMPARED TO OPPOSITE SIDE

CASE 1CASE 1 D.M.D.M.

PREVIOUS INVESTIGATIONS:PREVIOUS INVESTIGATIONS:

3 ORTHOPAEDIC OPINIONS3 ORTHOPAEDIC OPINIONSX-RAYX-RAYCT SCANCT SCANU/S SCANU/S SCAN

GILMORE: Fourth OpinionGILMORE: Fourth Opinion

PREVIOUS TREATMENT:PREVIOUS TREATMENT:

COMPLETE RESTCOMPLETE RESTPHYSIOTHERAPYPHYSIOTHERAPYMANIPULATIONMANIPULATIONLOCAL STEROIDSLOCAL STEROIDS

CASE 2 .G.S Tertiary OpinionCASE 2 .G.S Tertiary OpinionMF : ABERDEEN & SCOTLANDMF : ABERDEEN & SCOTLAND

PRESENTED:PRESENTED: 16.3.81 GROIN PAIN R > L16.3.81 GROIN PAIN R > L

SYMPTOMS:SYMPTOMS: 15 WEEKS :15 WEEKS :Following Over Stretching Eversion InjuryFollowing Over Stretching Eversion Injury

LAST GAME:LAST GAME: 15 WEEKS (30.12.80)15 WEEKS (30.12.80)

PAIN TROTTINGPAIN TROTTINGSUDDEN MOVEMENTSUDDEN MOVEMENTKICKINGKICKINGCOUGHINGCOUGHINGSNEEZINGSNEEZING

ONLY ABLE TO WALKONLY ABLE TO WALK

CASE 2 – GSCASE 2 – GSPHYSICAL SIGNSPHYSICAL SIGNS

INSPECTION:INSPECTION: No SwellingNo Swelling

PALPATION:PALPATION: No Lump No HerniaNo Lump No Hernia

PALPATION VIA SCROTUMPALPATION VIA SCROTUM

-- DILATED R S.I.R. - READILY ADMITTED FINGERDILATED R S.I.R. - READILY ADMITTED FINGER

-- COUGH IMPULSECOUGH IMPULSE

-- FINGER IN R S.I.R. FINGER IN R S.I.R. TENDERNESSTENDERNESS

PAINPAIN

My Conclusion after History & My Conclusion after History & ExaminationExamination

Torn Groin Muscles & or TendonsTorn Groin Muscles & or TendonsProbablyProbably

External Oblique MuscleExternal Oblique Muscle

Conjoined TendonConjoined Tendon

ACTUAL PATHOLOGYACTUAL PATHOLOGYFound at OperationFound at Operation

TORN EXTERNAL OBLIQUE ====TORN EXTERNAL OBLIQUE ==== DILATED DILATED SUPERFICIAL SUPERFICIAL INGUINAL RINGINGUINAL RING

TORN CONJOINED TENDONTORN CONJOINED TENDON

CONJOINED TENDONCONJOINED TENDON

}} DEHISCENCEDEHISCENCEINGUINAL LIGAMENTINGUINAL LIGAMENT

D. M. Post OperativelyD. M. Post Operatively

• Training Fully at 3 weeksTraining Fully at 3 weeks

• Spurs Team at 5 weeksSpurs Team at 5 weeks

Post Operatively

Training with Aberdeen 3 wks

In Scotland Squad 7 wks

GILMORE’S GROIN GILMORE’S GROIN

GROIN DISRUPTIONGROIN DISRUPTION

SPORTSMEN GROINSPORTSMEN GROIN

(Sportsmen Hernia:Wrong(Sportsmen Hernia:Wrongas NO HERNIA )as NO HERNIA )

GROIN DISRUPTION GROIN DISRUPTION TYPICAL PATIENTTYPICAL PATIENT

• YOUNG MALEYOUNG MALE

• ACTIVE SPORTSMENACTIVE SPORTSMEN

• RARE OVER 45RARE OVER 45

• RARE IN FEMALES (1%)RARE IN FEMALES (1%)

GROIN DISRUPTIONGROIN DISRUPTION

• MUSCULO – TENDINOUS INJURYMUSCULO – TENDINOUS INJURY

• ALL LAYERS GROINALL LAYERS GROIN

• INGUINAL + ADDUCTOR (40%)INGUINAL + ADDUCTOR (40%)

• ““MUSCLE DISLOCATION”MUSCLE DISLOCATION”

Only 1% Operative Cases Female Only 1% Operative Cases Female

GROIN DISRUPTIONGROIN DISRUPTION(GILMORE’S GROIN)(GILMORE’S GROIN)

31 YEARS31 YEARS

1980 - 20101980 - 2010

PATIENT REFERRAL RELATED TO SPORTPATIENT REFERRAL RELATED TO SPORT1980 - 20101980 - 2010

CASESCASES %%

ASSOCIATION FOOTBALLASSOCIATION FOOTBALL 43234323 5656

RUGBY UNION & LEAGUERUGBY UNION & LEAGUE 731731 99

ATHLETESATHLETES 372372 55

RACQUET GAMESRACQUET GAMES 298298 44

CRICKETCRICKET 175175 22

HOCKEYHOCKEY 152152 22

OTHER SPORTSOTHER SPORTS 912912 1212

NO SPORTNO SPORT 775775 1010

________________________________________________________________________________________________________

TOTALTOTAL 77387738 100100

OPERATIONSOPERATIONS1980 - 20101980 - 2010

TOTAL TOTAL 44664466

MALEMALE 4423 4423 (99%)(99%)

FEMALEFEMALE 4343 (1%)(1%)

INCIDENCE OF OPERATION INCIDENCE OF OPERATION RELATED TO SPORTRELATED TO SPORT

1980 - 20101980 - 2010CASESCASES OPNOPN %%

ASSOCIATION FOOTBALL **ASSOCIATION FOOTBALL ** 43234323 29812981 69 69 RUGBY UNION + LEAGUE ** RUGBY UNION + LEAGUE ** 731731 468468 6464CRICKET** CRICKET** 175175 118118 6868

ATHLETESATHLETES 372372 151151 3939RACQUET GAMESRACQUET GAMES 298298 101101 3434HOCKEYHOCKEY 152152 8888 5588OTHER SPORTSOTHER SPORTS 912912 307307 3434NO SPORTNO SPORT 775775 252252 3232____________________________________________________________________________________________________________________

TOTALTOTAL 77387738 4466 4466 58 58

INCIDENCE OF OPERATIONS INCIDENCE OF OPERATIONS ASSOCIATION FOOTBALL 1980 - 2010ASSOCIATION FOOTBALL 1980 - 2010

TOTALTOTAL OPNOPN %%

PROFESSIONALPROFESSIONAL 15461546 12751275 8282

SEMI PRO.SEMI PRO. 755755 538 538 7171

AMATEURAMATEUR 20222022 11681168 5757______________________________________________________________________________________________

TOTALTOTAL 43234323 29812981 6969

PROFESSIONAL FOOTBALLERSPROFESSIONAL FOOTBALLERS1980 - 20101980 - 2010

CASES CASES 15461546

OPERATIONSOPERATIONS 1275 1275 (82%)(82%)

ENGLISH FOOTBALL LEAGUEENGLISH FOOTBALL LEAGUECLUBSCLUBS

92 CLUBS92 CLUBS

PATIENTS REFERRED BY 91PATIENTS REFERRED BY 91

AETIOLOGY:MUSCLE IMBALANCEAETIOLOGY:MUSCLE IMBALANCE( Recurrent Microtrauma ) ( Recurrent Microtrauma )

1. 1. STRONG HIP FLEXORS STRONG HIP FLEXORS PULL PELVIS DOWNPULL PELVIS DOWN (QUADS)(QUADS)2.2. TILTED PELVISTILTED PELVIS STRETCH ABDO MUSCLESSTRETCH ABDO MUSCLES

3. STRETCHED ABDO MUSCLES 3. STRETCHED ABDO MUSCLES BECOME WEAKBECOME WEAK (OBLIQUES)(OBLIQUES) FAIL TO STABILIZE PELVIS FAIL TO STABILIZE PELVIS

44. . OVERUSEOVERUSE RECURRENT TEARS RECURRENT TEARS GROIN DISRUPTIONGROIN DISRUPTION

5. MALE > FEMALE (99%) 5. MALE > FEMALE (99%)

ARSENAL F.C.: GILMORE’S GROINARSENAL F.C.: GILMORE’S GROIN

OPERATIONOPERATION P.A.P.A.

1986 – 1996 (GRAHAM) 33 3

1997 – 2007 (WENGER) 10 1

Gary Lewin 2007

ONSET OF SYMPTOMSONSET OF SYMPTOMS

INSIDIOUSINSIDIOUS 72%72%

SPECIFIC INJURYSPECIFIC INJURY 28%28%

OVERSTRETCHINGOVERSTRETCHING

MISKICKINGMISKICKING

ABDUCTIONABDUCTION

EVERSION EVERSION

SYMPTOMS DURING EXERCISESYMPTOMS DURING EXERCISE

PAIN IN GROIN INCREASES WITHPAIN IN GROIN INCREASES WITH

RUNNINGRUNNING

STRIDINGSTRIDING

SPRINTINGSPRINTING

SUDDEN MOVEMENTSUDDEN MOVEMENT

TWISTING & TURNINGTWISTING & TURNING

SIDE STEPPINGSIDE STEPPING

JUMPINGJUMPING

DEAD BALL KICKINGDEAD BALL KICKING

LONG BALL KICKINGLONG BALL KICKING

SYMPTOMS AFTER EXERCISESYMPTOMS AFTER EXERCISE

PAIN IN GROIN INCREASES WITHPAIN IN GROIN INCREASES WITH

TURNING IN BEDTURNING IN BED

GETTING OUT OF BEDGETTING OUT OF BED

GETTING OUT OF CARGETTING OUT OF CAR

SIT UPSSIT UPS

COUGHINGCOUGHING

SNEEZINGSNEEZING

SUDDEN MOVEMENTSUDDEN MOVEMENT

STIFF & SORE

EXAMINATIONEXAMINATION

GROIN DISRUPTION: GROIN DISRUPTION: PHYSICAL SIGNSPHYSICAL SIGNS

(ALL ELICITED VIA SCROTUM)(ALL ELICITED VIA SCROTUM)

S.I.R:S.I.R: DILATED (+/-)DILATED (+/-)COUGH IMPULSECOUGH IMPULSETENDERTENDER(PALPABLE TEAR)(PALPABLE TEAR)

TENDERNESS:TENDERNESS: MAY BE EXQUISITEMAY BE EXQUISITEDIMINISHES WITH RESTDIMINISHES WITH REST

INVESTIGATIONSINVESTIGATIONS

STORK VIEWSSTORK VIEWS (FLAMINGO)(FLAMINGO)

MRI in Groin DisruptionMRI in Groin Disruption

MRI Poor in AbdomenMRI Poor in Abdomen

Resolution insufficient for subtle changesResolution insufficient for subtle changesBut Inguinal ligament – clearly visibleBut Inguinal ligament – clearly visible

GapsGapsDefectsDefectsSignificant DisruptionSignificant DisruptionGross Scar TissueGross Scar Tissue

MRI Good in Pelvis & ThighMRI Good in Pelvis & Thigh

Osteitis pubisOsteitis pubisHIP PathologyHIP PathologyAdductor TearsAdductor Tears

Also visible

clearly seen

David Connell 2009

Ultrasound in Groin DisruptionUltrasound in Groin Disruption

State of Art Ultrasound Equipment – requiredState of Art Ultrasound Equipment – required

Subtle changes in Inguinal ligamentSubtle changes in Inguinal ligament

Conjoined TendonConjoined Tendon

Dynamic assessment – EssentialDynamic assessment – Essential

Abdominal strainingAbdominal straining

SonopalpationSonopalpation

Tender over Inguinal CanalTender over Inguinal Canal

Bulging Post. WallBulging Post. Wall

maybe seen

David Connell 2009

INDICATIONS FOR SURGERYINDICATIONS FOR SURGERY

PROFESSIONALPROFESSIONAL

ANDAND

AMATEURAMATEUR

FAILED CONSERVATIVE FAILED CONSERVATIVE TREATMENTTREATMENT

INDICATION FOR INDICATION FOR SURGERY: SURGERY:

PROFESSIONALSPROFESSIONALS

GAME INHIBITEDGAME INHIBITED

TRAINING INHIBITEDTRAINING INHIBITED

LOSS OF LOSS OF SPEEDSPEED

LOSS OF LOSS OF FITNESSFITNESS

INDICATION INDICATION FOR SURGERY: FOR SURGERY:

AMATEURSAMATEURS

SYMPTOMS AFFECTSYMPTOMS AFFECT

EVERYDAY LIFEEVERYDAY LIFE

LOSS OF SPORT AFFECTS LOSS OF SPORT AFFECTS QUALITY OF LIFEQUALITY OF LIFE

Principle Groin Disruption Principle Groin Disruption SurgerySurgery

Groin ReconstructionGroin Reconstruction

• Normal Anatomy – RestoredNormal Anatomy – Restored

• Each layer & Each Injury– RepairedEach layer & Each Injury– Repaired

• A Layer of Permanent Suture – EssentialA Layer of Permanent Suture – Essential

• Preferable to Absorbable Sutures (Don’t Last)Preferable to Absorbable Sutures (Don’t Last)

• Preferable to Mesh (May Restrict Mobility)Preferable to Mesh (May Restrict Mobility)

GROIN DISRUPTIONGROIN DISRUPTION& ADDUCTOR TEAR& ADDUCTOR TEAR

PRESENT IN 40%PRESENT IN 40%

GROIN DISRUPTIONGROIN DISRUPTION& ADDUCTOR TEAR& ADDUCTOR TEAR

TREATMENTTREATMENT

MODERATE or ACUTE : MODERATE or ACUTE : REPAIR DISRUPTION +REPAIR DISRUPTION +

INTENSIVE ADDUCTOR PHYSIO INTENSIVE ADDUCTOR PHYSIO

SEVERE or CHRONIC : REPAIR DISRUPTION +SEVERE or CHRONIC : REPAIR DISRUPTION +

ADDUCTOR TENOTOMY (18%)ADDUCTOR TENOTOMY (18%)

RESULT : GROIN RECONSTRUTION RESULT : GROIN RECONSTRUTION SUCCESSFULSUCCESSFUL

97%97%

AVERAGE RETURN TO PROFESSIONAL AVERAGE RETURN TO PROFESSIONAL FOOTBALL 4 WEEKSFOOTBALL 4 WEEKS

1220 1220 OUT OFOUT OF 1258 1258 PLAYERSPLAYERS

RANGE RANGE 3 - 7 3 - 7 WEEKSWEEKS

Recurrent Groin Disruption

SAME SIDE: True Recurrence 3%

Unoperated Side : 10% C/o Pain within 10 Years Recognize the Symptoms & Request Operation (knowing it will cure the Symptoms

INTERNATIONAL SOCCER INTERNATIONAL SOCCER FOOTBALLERSFOOTBALLERS

1980 - 20101980 - 2010

ENGLANDENGLAND 5959SCOTLANDSCOTLAND 3434NORTHERN IRELANDNORTHERN IRELAND 1188

EIREEIRE 1166

WALESWALES 1515

OTHEROTHER 115115______

257257

OTHER SOCCER INTERNATIONALSOTHER SOCCER INTERNATIONALS1980 -20101980 -2010

UAEUAE 3838

QATARQATAR 2121

KUWAITKUWAIT 77

NORWAYNORWAY 5 5

AUSTRALIAAUSTRALIA 44

JAMAICAJAMAICA 4 4

COLUMBIACOLUMBIA 3 3

PORTUGALPORTUGAL 3 3

ARGENTINAARGENTINA 2 2

DENMARKDENMARK 2 2

FINLANDFINLAND 2 2

HOLLANDHOLLAND 2 2

ICELANDICELAND 2 2

NEW ZEALANDNEW ZEALAND 22

USAUSA 2 2

BRAZILBRAZIL 11

CROATIACROATIA 1 1CZECH REPUBLICCZECH REPUBLIC 1 1EGYPTEGYPT 11FRANCEFRANCE 11GERMANYGERMANY 1 1HONG KONGHONG KONG 11HUNGARYHUNGARY 11IVORY COASTIVORY COAST 11LATVIALATVIA 1 1NIGERIANIGERIA 1 1RUSSIARUSSIA 1 1SLOVAKIASLOVAKIA 1 1SWEDENSWEDEN 1 1TRINIDADTRINIDAD 11ZAIREZAIRE 1 1

________________________________________________________TOTAL TOTAL 115115

RUGBY UNIONRUGBY UNION1980 - 20101980 - 2010

REF.REF. OPN.OPN. Op % Op %

631631 393393 (44 I NT) (44 I NT) 6622

RUGBY SYMPTOMS

BACKS

Sprinting

Twisting and Turning

Accelerating

Striding out

Side Stepping

Dead Ball Kicking

RUGBY SYMPTOMS

FORWARDS

Sprinting

Twisting and Turning

Striding out

Up after a tackle

Jumping

R.U. INTERNATIONALS: POSITIONR.U. INTERNATIONALS: POSITION44 PLAYERS44 PLAYERS

BACKSBACKS FORWARDSFORWARDS

½ BACKS 12 FRONT ROW 8½ BACKS 12 FRONT ROW 8

CENTRES 9 SECOND ROW 2 CENTRES 9 SECOND ROW 2

WING/F.B WING/F.B 55 BACK ROW 8BACK ROW 8

Total: 26(60%) 18(40%)Total: 26(60%) 18(40%)

RUGBY LEAGUERUGBY LEAGUE1980 - 20101980 - 2010

REF.REF. OPN.OPN.%%

9595 75 (17 INT)75 (17 INT)7799

CRICKETCRICKET1980 - 20101980 - 2010

REF. OPN.REF. OPN. %%

175 118 (23 INT) 175 118 (23 INT) 6868

INTERNATIONAL CRICKETERS

1988 - 2010

FAST BOWLER 13

BATSMAN 6

ALL ROUNDER 4

TOTAL 23

SYMPTOMS IN CRICKETERS

PAIN IN GROIN

(Specific injury :unusual)

FAST BOWLERS: LOOSE PACE

PAIN in Groin Drag > Landing

BATSMAN: RUNNING BETWEEN WICKETS

TWISTING & TURNING

FIELDERS: SUDDEN MOVEMENT

PUSHING OFF

STRIDING OUT

DIVING

20/20 Games: INCREASED INCIDENCE

SYMPTOMS IN ATHLETICS

PAIN IN GROIN

MIDDLE & LONG DISTANCE RUNNERS

HURDLERS

TRIATHLETES

SPRINTERS (UNUSUAL)

PAIN INCREASES: WITH DISTANCE

SPRINTING AT END OF RACE

LOSS OF SPEED:

REDUCED TIMES

LOSS OF ENDURANCE:

SLOW RECOVERY

ATHLETESATHLETES1980 - 20101980 - 2010

REF. OPN.REF. OPN. %%

372 151 (24 INT)372 151 (24 INT) 4040

SYMPTOMS IN FIELD HOCKEY

PAIN IN GROIN

ELITE PLAYERS

FREQUENT GAMES ON ASTROTURF

SPRINTING

TWISTING & TURNING

LOSS OF SPEED

(CORNER SPECIALISTS)

FIELD HOCKEYFIELD HOCKEY1980 - 20101980 - 2010

REF. OPN.REF. OPN.%%

152 88 (15 INT)152 88 (15 INT) 5588

RACQUET GAMES RACQUET GAMES PLAYERSPLAYERS

1980 – 20101980 – 2010

REF. OPN. %REF. OPN. %

298 101 (3 INT) 34298 101 (3 INT) 34

ALL OTHER ALL OTHER SPORTSSPORTS

Including Keep Fit Including Keep Fit 1980 - 20101980 - 2010

REF.REF. OPN.OPN. %%

912912 307 (26 INT)307 (26 INT) 3434

ICE HOCKEYICE HOCKEY

GOLF

FENCINGFENCING

HURLING

GAELIC FOOTBALL

GYMANASTSGYMANASTS

LACROSSELACROSSE

• MARTIAL ARTSMARTIAL ARTS

• KICK BOXINGKICK BOXING

• WATERPOLOWATERPOLO

• WEIGHT LIFTINGWEIGHT LIFTING

• STRONGMENSTRONGMEN

• SKIINGSKIING

• SNOW BOARDINGSNOW BOARDING

INTERNATIONALS 1980-2010INTERNATIONALS 1980-2010SOCCER SOCCER 257257

RUGBY UNION RUGBY UNION 4444

ATHLETESATHLETES 2424

CRICKETCRICKET 2222

RUGBY LEAGUERUGBY LEAGUE 1717

HOCKEYHOCKEY 1515

HANDBALLHANDBALL 4 4

RACQUET GAMESRACQUET GAMES 44

SKIINGSKIING 22

BASKETBALLBASKETBALL 2 2

FENCING FENCING 2 2LACROSSELACROSSE 2 2MARTIAL ARTS MARTIAL ARTS 3 3ICE HOCKEYICE HOCKEY 22GYMNASTICSGYMNASTICS 1 1WATERPOLOWATERPOLO 1 1ROWINGROWING 11"STRONGMAN" "STRONGMAN" 1 1WEIGHT LIFTING WEIGHT LIFTING 1 1

______________________________________________

TOTALTOTAL 407407

NO SPORTNO SPORT1980 - 20101980 - 2010

REF.REF. OPN.OPN. %%

775775 252 252 3333

BUILDERS. GARDENERS. DIY. POLICE and PORN STARS

SPORTSWOMENSPORTSWOMEN

GILMORE’S GROIN IN WOMEN: GILMORE’S GROIN IN WOMEN: DIAGNOSISDIAGNOSIS

DIFFICULT:DIFFICULT: NO SCROTUMNO SCROTUM

BASED ON:BASED ON: HISTORYHISTORY

TENDER S.I.R.TENDER S.I.R.

GROIN PAIN WITH RESISTED HIP FLEXIONGROIN PAIN WITH RESISTED HIP FLEXION

ELEVATION FROM SUPINE POSITION GRIMACEELEVATION FROM SUPINE POSITION GRIMACE

FEMALESFEMALES1980 - 20101980 - 2010

REF.REF. OPN.OPN.%%

259259 43 (5 INT ) 43 (5 INT ) 17 17

DANCERSDANCERS

SCEPTICISM

31 Years No Groin 31 Years No Groin Disruption PatientDisruption Patient

Complained of Complained of SwellingSwelling

Groin Disruption/Gilmore’s GroinGroin Disruption/Gilmore’s Groin

Significantly different to HerniaSignificantly different to Hernia

InguinalInguinal

FemoralFemoral

ObturatorObturator

Only similarity: SITEOnly similarity: SITE

SYMPTONS & PATHOLOGYSYMPTONS & PATHOLOGY

DEPENDS ON DEPENDS ON

ACCURATE DIAGNOSIS ACCURATE DIAGNOSIS OfOf

PATHOLOGY PATHOLOGY

CORRECT SURGERYCORRECT SURGERY of ALL CONDITIONS of ALL CONDITIONS

Groin Disruption/Gilmore’s GroinGroin Disruption/Gilmore’s Groin Significantly different to HerniaSignificantly different to Hernia

REPAIR using Hernia Mesh TechniqueREPAIR using Hernia Mesh Technique

Open or Laparoscopic Methods Open or Laparoscopic Methods Usually FAILSUsually FAILS

PATHOLOGYPATHOLOGY

FUTUREFUTURE

Mr Simon MarshMr Simon MarshSurgical DirectorSurgical Director

108108

MARSH MODIFICATIONMARSH MODIFICATION

For For GROIN RECONSRUCTIONGROIN RECONSRUCTION

Thank YouThank You..