Editing Core muscle injuries

== Anatomical pathophysiology ==

* Core muscle weakness (usually from fraying associated with hyperextension or hyperabduction) results in an imbalance of forces on the pelvis
* This imbalance causes disruption of the attachments to firbocartilaginous plate of the pubic bone, causing pain, weakness and instability
* Loss of stability leads to compensation from the other structures that cross the pubic bone (iliopsoas, rectus femoris, sartorius) which can then become additional sources of pain and injury
* Anatomic variants predisposing to certain injuries:
** Symptomatic femoroacetabular impingement results in spasms of the adductors (primarily adductor longus) and hip flexors (primarily rectus femoris)

== Differential diagnosis of groin pain in athletes ==

* Hip
** Acetabular labral tear and femoroacetabular impingement
** OA
** Snapping hip syndrome and iliopsoas tendonitis
** Avascular necrosis
** Iliotibial band syndrome
* Visceral
** Inguinal hernia
** Other abdo hernias
** Testicular torsion
* Infectious
** Septic arthritis
** Osteomyelitis
** PID
** Prostatitis
** Epididymitis and orchitis
** Herpes
* Inflammatory
** Endometriosis
** IBD
** PID
** Primary osteitis pubis
* Traumatic
** Stress fracture
** Tendon avulsion
** Muscle contusion
** Baseball pitcher-hockey goalie syndrome
* Developmental
** Apophysitis
** Growth plate stress injury or fracture
** Legg-Calve-Perthes syndrome
** Developmental dysplasia
** Slipped capital femoral epiphysis
* Neurologic
** Nerve entrapment syndromes
** Referred pain
** Sacroileitis
** Sciatis entrapment (piriformis syndrome)
** Hamstring strain
** Knee pain
* Neoplastic
** Testicular cancer
** Osteoid osteoma

== Diagnostic approach ==

* Basic history aligned to above categories
* Classically, these injuries improve with rest, but pain returns upon resuming activities
* FABER/FADIR test
* Localised tenderness
* Imaging
** Plain films
** MRI - 'athletic pubalgia protocol'
*

== Management ==

* Principles
** Injuries involving central pubic bone attachments generally leave an athlete with instability that cannot be corrected until normal anatomy is restored
* Non-operative
** PT to strengthen lateral and posterior core muscles to offload the injury and stabilise the pubic joint
** Corticosteroid injections to the affected area can temporise the issue in about 80% of patients, and do not seem to result in subsequent worse operative outcomes



[[Category:Abdo wall and retroperitoneum]]