Sports Hernia/Athletic Pubalgia non mesh repair

[pubalgia2019]

quote DrBrown:

Dear Pubalgia2019
Adductor injuries often improve after a steroid injection.
Ask your local doctor to inject the origin of the adductor longus tendon and the surrounding periosteum with marcaine and decadron.
If your local doctor has any questions I would be pleased to talk with them.
If you do not improve in a few months, then surgery is an option.
Regards.
Bill Brown MD

Thanks, Dr. Brown! Will ask the local doctor and go from there.

Still hoping I can avoid surgery, yet I’m dying to go back to playing soccer. It’s one of those 50-50 things. I heard of many patients with my diagnostic and went back to playing, while others did surgery. So it’s tough to gauge that…

[DrBrown]

Dear Pubalgia2019
Adductor injuries often improve after a steroid injection.
Ask your local doctor to inject the origin of the adductor longus tendon and the surrounding periosteum with marcaine and decadron.
If your local doctor has any questions I would be pleased to talk with them.
If you do not improve in a few months, then surgery is an option.
Regards.
Bill Brown MD

[ctguy]

yes, will update the thread in a few weeks as I progress.

[pubalgia2019]

quote ctguy:

FWIW, on my “small” SH… I just went through PRP last Friday and as the doctor put it when he inserted the needle into the base of my RA (where there was asymmetrical thinning), he said “wow, thats crunchy”. Turns out there was calcification in the wound where he did the PRP injection and where the pain was. The pain for me happened only during certain movements.

The doctor explained (as he was breaking up the calcium with the needle), muscles as they rub up against the calcified area can feel it and cause pain.

Its only been a week, so we’ll see where this goes.

Also, I had a small partial tear in my AL at its pubic insertion that has gotten much better. This area also injected with PRP, but no crunch there.

Thanks. This helps! I think my ultrasound showed calcification. They took a while to look at it and said it was calcification likely from a previous injury in that area.

I wonder if I should look into PRP. It seems like you had a similar injury with the small tear.

[ctguy]

FWIW, on my “small” SH… I just went through PRP last Friday and as the doctor put it when he inserted the needle into the base of my RA (where there was asymmetrical thinning), he said “wow, thats crunchy”. Turns out there was calcification in the wound where he did the PRP injection and where the pain was. The pain for me happened only during certain movements.

The doctor explained (as he was breaking up the calcium with the needle), muscles as they rub up against the calcified area can feel it and cause pain.

Its only been a week, so we’ll see where this goes.

Also, I had a small partial tear in my AL at its pubic insertion that has gotten much better. This area also injected with PRP, but no crunch there.

[pubalgia2019]

quote drtowfigh:

Time and rest are the best healers for sports hernia, adductor Or rectus tears or strain. We don’t operate usually for strains or grade 1 tears.

Thank you for your answer. I was just concerned that it has been months (January 2019) and now at least 10 weeks of full rest since last MRI and injury, with no running and that I still feel a stab with certain lunges or certain movements.

It’s a 1 pain on a scale to 10, but enough to be afraid to start running or playing.

Also thanks for clarifying that’s a Grade 1, I wasn’t sure if it’s a 2 based on the results.

[drtowfigh]

Time and rest are the best healers for sports hernia, adductor Or rectus tears or strain. We don’t operate usually for strains or grade 1 tears.

[pubalgia2019]

I forgot to tag doctor [USER=”935″]drtowfigh[/USER] and [USER=”2580″]DrBrown[/USER]

[pubalgia2019]

I have a similar issue, rehabbed first for 6 weeks, felt okay, went back to playing soccer, got injured again. 2 weeks of decent pain when coughing or sneezing, then it slowly started to go away. Did an MRI with AP protocol and MSK Ultrasound, and been rehabbing again for the past 6-7 weeks, mostly core, hip, strength, dry needling.

Pain is gone for normal activities, like running in straight line or lateral runs, but at certain movement of my leg (angles) or if I do lateral and forward lounges, I can still feel some pain in my groin. So I’m afraid to go back to playing.

Any thoughts on whether I need more time to heal? I know surgery can fix it, but since I don’t have every day pain, was wondering if it’s better to avoid it.

Here are the results:

PROCEDURE: MRI PELVIS MSK WO CONTRAST
TECHNIQUE: Multiplanar MRI of the pelvis was performed utilizing noncontrast T1-weighted and fluid sensitive sequences.
COMPARISON: Prior sports hernia ultrasound dated 5/1/2019. Pelvic radiograph dated 1/28/2019.

FINDINGS:

The femoral heads are well-formed and seated within well-formed acetabula. There is no femoral avascular necrosis, fracture or significant osteoarthritis.

Minimal L5-S1 disc desiccation is seen. The sacroiliac joints and symphysis pubis are intact.

There is no hip effusion, iliopsoas or trochanteric bursitis.

There is mild left adductor origin tendinosis with a low-grade partial-thickness tear. The right adductor tendon origin is intact. The rectus abdominis-adductor longus aponeurotic plate is intact.

The tendinous insertions of the gluteal, iliopsoas, and hamstring origins are intact.

There is no muscle atrophy. Grade 1 strains of the left adductor musculature are seen.

IMPRESSION:

Low-grade partial-thickness left adductor origin tendon tear superimposed on mild tendinosis and grade 1 left adductor muscle strains.

—————————————————–

PROCEDURE: US SPORTS HERNIA

HISTORY: Left groin pain.

TECHNIQUE: Targeted ultrasound was performed using a high frequency linear array transducer.

COMPARISON: 10/26/2016

FINDINGS/
IMPRESSION:

Visualized rectus abdominis musculature and insertion are intact.

There is mild tendinosis of the right adductor origin without tearing.

There is thickening, hypoechogenicity, and irregularity of the left adductor origin with scattered areas of calcification, likely related to degeneration/prior trauma. No high-grade tear is identified. There is mild associated hypervascularity at the left adductor origin, consistent with a low-grade strain.

No inguinal hernia is identified on the left with dynamic imaging.

[ctguy]

Thank you!

[drtowfigh]

Sounds like a small sports hernia. Nothing that would require mesh or surgery unless you fail all attempts at healing.

[ctguy]

Results from MRI from the report (not the doctor), I can’t seem to clearly see what these two mean and not sure if they are an indication of surgery being necessary.
1. small partial tear of the right adductor longus aponeurosis at its pubic origin
2. asymmetric thinning of the distal right rectus abdominalis muscle at its pubic insertion

Can anyone interpret in english?

Thank you.

[ctguy]

It does… I’ve made an appointment with Litwin & Busconi in Mass, not too far away. I’ve read somewhere they worked/trained under Meyers so would use the same technique. I am really looking for guidance from them on either “you can rehab this” or “you need surgery to get to pre-injury status”. I am also considering PRP injections, but wary of the cost if I ultimately need surgery.

[Good intentions]

Does “ct” stand for Connecticut? The Vincera Institute and Dr. William Meyers, down in Philadelphia, is well known for fixing athletes. I posted a link below. I sent them my images and he took a quick look at them. But he likes to use his own MRI technique.

I see that you mentioned mesh again, to repair torn muscles and athletic pubalgia. I have only followed the problem for a short while but my impression is that the use of mesh for athletic pubalgia started from a basic misunderstanding about what the problem actually was. Or just an attempt to find another market for mesh. And it did not work well, people in the know don’t use it for that anymore. Your surgeon seems behind the times.

Good luck. Marcia at the Institute is very helpful, you could probably just call. She will reply to an email also.

https://vincerainstitute.com/

https://vincerainstitute.com/about

[ctguy]

Results from MRI… torn oblique and rectus abdominus, adductor strained (doctor explained it was “pulled down” from where it is normally attached, but not torn).

The doctor was very nice and explained things well, but recommend a robotic approach because of concern needing to likely cut through the old patch and related scar tissue. He also mentioned the mesh he used is a Bard/poly mesh, but uses only what is absolutely necessary.

If this doctor is most comfortable doing a robot/lap procedure I can’t fault him for that, but I’d like to know if an open procedure can be done without risk to the old patch/plug that’s been there for 15 years. I have the MRI disc, whats the best way to go about getting a second opinion from known “open” doctors who are not local to me?

Thank you.

[ctguy]

Thank you, hopefully won’t come to that, but very good to know.

[DrBrown]

Dear Ctguy.
A open repair can be done even with the mesh.
Regards.
Bill Brown MD

[ctguy]

Thank you, intend to go that route. If surgery will be required, is open a possibility on the same side as a mesh/plug repair from years ago?

[DrBrown]

Dear Ctguy.
I agree with Dr. Towfigh. Try conservative measures first. If that fails, then most surgeons would advise a non mesh repair.
Regards.
Bill Brown MD

[drtowfigh]

Surgery is not the first line of therapy or even the second line for sports hernias. Injections will help and rest. Most don’t use mesh for sports hernia.