prof. dr. c.h.j. van eijck afd. heelkunde sportershernia/plaatsen matje
TRANSCRIPT
![Page 1: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/1.jpg)
Prof. dr. C.H.J. van Eijck
Afd. Heelkunde
“Sportershernia/plaatsen matje”
![Page 2: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/2.jpg)
Chirurg
![Page 3: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/3.jpg)
Clubarts
![Page 4: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/4.jpg)
![Page 5: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/5.jpg)
Sportsman’s hernia
![Page 6: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/6.jpg)
![Page 7: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/7.jpg)
Sportsman’s hernia
• Chronic groin painChronic groin pain– Incidence: 6%– 60% during active soccer carier– 50% > 20 weeks complaints
• Differential diagnosisDifferential diagnosis
![Page 8: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/8.jpg)
Differential diagnosis Groin injury
• Muscle and tendon injuryMuscle and tendon injury– Tendon-bone or tendon-muscle – Avulsion fracture
• Adductor longus, rectus femoris or Adductor longus, rectus femoris or abdominisabdominis
• X-Pelvis, bone scan, ultrasound or X-Pelvis, bone scan, ultrasound or
MRIMRI
![Page 9: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/9.jpg)
Differential diagnosis Groin injury
• Osteïtis pubisOsteïtis pubis– Painfull symfysis and adductor-
tenoperiostitis– Direct trauma– Pelvic instability/Sacroiliacal
abnormalities
• 25% Radiologic abnormalities25% Radiologic abnormalities
• X-Pelvis, X-Pelvis, bone scan, ultrasound or , ultrasound or MRIMRI
![Page 10: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/10.jpg)
Osteïtis pubisOsteïtis pubis
![Page 11: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/11.jpg)
Osteïtis pubisOsteïtis pubis
![Page 12: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/12.jpg)
Differential diagnosis Groin injury
• StressfractureStressfracture– Ramus inferior os pubis (5%)– Collum femoris avascular
necrosis Femur head
• X-Pelvis, bone scan, (MRI)X-Pelvis, bone scan, (MRI)
![Page 13: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/13.jpg)
Differential diagnosis Groin injury
• Urologic diseaeUrologic diseae– Prostatitis– Epididymitis– Urethritis– Hydrocèle testis– Non-descending testicle
• Rectal toucher, bact. culture, Rectal toucher, bact. culture, ultrasoundultrasound
![Page 14: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/14.jpg)
Differential diagnosis Groin injury
•Hip en Spine diseaseHip en Spine disease
– Osteochondritis lumbal verterbra– M. Scheuermann– Discus pathology., L1 en L2
– Cam type femoroacetabular impingement– Congenital hipdysplasia– Epifysiolysis femur headkop– Avascular necrosis femur head
•X-LWK (+3/4), X-femur (Faux-profile), bone scan and X-LWK (+3/4), X-femur (Faux-profile), bone scan and CT-scan (arthography)CT-scan (arthography)
![Page 15: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/15.jpg)
Differential diagnosis Groin injury
• Nerve entrapment/previous Nerve entrapment/previous surgerysurgery– N. ilio-inguinalis (symfysis)– N. genitofemoralis (testicle)
![Page 16: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/16.jpg)
Differential diagnosis Groin injury
• Nerve entrapment/previous Nerve entrapment/previous surgerysurgery– N. ilio-inguinalis (symfysis)– N. genitofemoralis (testicle)– N. obturatorius (med. thigh and
adductor weakness)
• Proof blockade and/or EMGProof blockade and/or EMG
![Page 17: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/17.jpg)
N. obturatorius (med. thigh and adductor
weakness)
Nerve entrapmentNerve entrapmentN. obturatorius (med. thigh and
adductor weakness)
![Page 18: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/18.jpg)
Physical examination Groin injury
Renee DannenburgRenee Dannenburg
![Page 19: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/19.jpg)
Physical examination Groin injury
• Lower back, SI Joint and hipLower back, SI Joint and hip• Abdominal musclesAbdominal muscles• Muscles of the upper legsMuscles of the upper legs• Rectal toucherRectal toucher• Palp funiculus and testiclesPalp funiculus and testicles
![Page 20: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/20.jpg)
Physical examination Groin injury
• Lower back, SI Joint and hipLower back, SI Joint and hip• Abdominal musclesAbdominal muscles• Muscles of the upper legsMuscles of the upper legs• Rectal exam., palp funiculus and Rectal exam., palp funiculus and
testiclestesticles
• Painfull int. and ext. annulus with Painfull int. and ext. annulus with elevated intra-abdominal pressureelevated intra-abdominal pressurePainfull int. and ext. annulus Painfull int. and ext. annulus with elevated intra-abdominal with elevated intra-abdominal
pressurepressure
![Page 21: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/21.jpg)
Sportsman’s hernia
• Weakness of the post. inguinal wallWeakness of the post. inguinal wall• Symptomatic non-palpable herniaSymptomatic non-palpable hernia• Disruption of the ext. obl. Disruption of the ext. obl.
aponeurosisaponeurosis• PubalgyPubalgy
![Page 22: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/22.jpg)
Complaints
• Long existing groin painLong existing groin pain• Pain around the external annulusPain around the external annulus• Combination with adductor-Combination with adductor-
tendopathytendopathy• Good reaction on NSAID’sGood reaction on NSAID’s• Increased pain with elevated intra-Increased pain with elevated intra-
abdominal pressureabdominal pressure
![Page 23: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/23.jpg)
PathofysiologySportsman’s hernia
Post wall inguinal canal: fascia Post wall inguinal canal: fascia transversalistransversalis
No striated muscle fibersNo striated muscle fibers
Funiculus through the int. annulusFuniculus through the int. annulus
![Page 24: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/24.jpg)
PathofysiologySportsman’s hernia
![Page 25: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/25.jpg)
PathofysiologySportsman’s hernia
Post wall inguinal canal: fascia Post wall inguinal canal: fascia transversalistransversalis
No striated muscle fibersNo striated muscle fibersFuniculus through the int. annulusFuniculus through the int. annulus
Weakness post. wallWeakness post. wallLat. HerniaLat. Hernia
Tension peritoneumTension peritoneumNerve entrapmentNerve entrapment
![Page 26: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/26.jpg)
TreatmentSportsman’s hernia
• ConservativeConservative– Rest, Fysiotherapy and
NSAID’s
Renee Dannenburg
![Page 27: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/27.jpg)
TreatmentSportsman’s hernia
• ConservativeConservative– Rest, Fysiotherapy and
NSAID’s
• OperativeOperative– Strengthening of the post.
Wall of the inguinal canal– Conventional (Lichtenstein-
plastiek)– Laparoscopic
![Page 28: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/28.jpg)
PatientsSportsman’s hernia
• Since 1998 till present: n=240Since 1998 till present: n=240
• (Semi)professional n=98 (4 women) (4 women)• 76 soccer, 4 atletics , 3 tennis, 4 76 soccer, 4 atletics , 3 tennis, 4
cycling, 11 misc.cycling, 11 misc.
• Amateur n=142 (3 women) (3 women)• 127 soccer, 15 misc.127 soccer, 15 misc.
![Page 29: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/29.jpg)
• Mean Age: 25 Mean Age: 25 ± 4.5± 4.5 year (17-36) year (17-36)
• Time complaints: 3 months till >2 Time complaints: 3 months till >2 yearsyears
PatientsSportsman’s hernia
![Page 30: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/30.jpg)
DiagnosticsSportsman’s hernia
• Herniografie (n=7)– High false-negative
percentage
• Ultrasonography (n=167) • X-pelvic and femur
(n=68)• Bone scan (n=53)• CT-scan (n=22)• MRI (n=57)• Laparoscopy (n=1)
![Page 31: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/31.jpg)
Indirect H .inguinalis
1
2
![Page 32: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/32.jpg)
• Open Lichtenstein n=3Open Lichtenstein n=3• Laparoscopic TEP Laparoscopic TEP
n=237n=237• Tenotomy n=12Tenotomy n=12
• Left n=86Left n=86• Right n=89Right n=89• Both n=65Both n=65
PatientsSportsman’s hernia
![Page 33: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/33.jpg)
Total Extra Perinoneal (TEP)
![Page 34: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/34.jpg)
Total Extra Perinoneal (TEP)
![Page 35: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/35.jpg)
Total Extra Perinoneal (TEP)
![Page 36: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/36.jpg)
LaparoscopyTEP right
![Page 37: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/37.jpg)
Total Extra Perinoneal (TEP)
![Page 38: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/38.jpg)
Laparoscopy
![Page 39: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/39.jpg)
Laparoscopy
![Page 40: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/40.jpg)
Laparoscopy
![Page 41: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/41.jpg)
Total Extra Perinoneal (TEP)
![Page 42: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/42.jpg)
![Page 43: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/43.jpg)
Total Extra Perinoneal (TEP)
![Page 44: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/44.jpg)
• (Min.) lateral hernia n=65(Min.) lateral hernia n=65• (Min.) medial hernia n=24(Min.) medial hernia n=24• Preperitoneal lipoma n=39Preperitoneal lipoma n=39• Enlarged lymph nodes n=32Enlarged lymph nodes n=32• No abnormallities n=80No abnormallities n=80
Peroperative findingsSportsman’s hernia
![Page 45: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/45.jpg)
• Sup. woundinfection (S.aureus) Sup. woundinfection (S.aureus) (n=4)(n=4)
• Adductor longus tendinopathy Adductor longus tendinopathy (n=14)(n=14) tenotomie (n=4)tenotomie (n=4)
• Mesh irritation/seroma (ProleneMesh irritation/seroma (Prolene®®) ) (n=12)(n=12)
• Mesh displacement ( n=4)Mesh displacement ( n=4)• Giant cell tumor re prox. femur Giant cell tumor re prox. femur
(n=1)(n=1)
• Sports recoverySports recovery
ComplicationsSportsman’s hernia
![Page 46: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/46.jpg)
Sportsman’s herniaTime RevalidationWeek 0 - 1
Renee Dannenburg
Week 1 - 2
Week 2 - 3
Week 3 - 5
Week 6
![Page 47: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/47.jpg)
Sportsman’s herniaTime Purpose TherapyWeek 0 - 1 Wound recovery
Pain management
Walking 5 km/h
Week 1 - 2 Optimizing scar tissue
Preventing muscle atrophia
Aqua training
Power walking
Cycle ergometer
Isometric training Rect. Abd.
Steps
Week 2 - 3 Dynamic training Rect. Abd.
Functional exercise
Sit-ups
Running
Lunges
Week 3 - 5 Sport specific training Weight training
Normal training
Week 6 Normal training
![Page 48: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/48.jpg)
Sportsman’s hernia
![Page 49: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/49.jpg)
Sportsman’s hernia• RecoveryRecovery
– Without tenotomy: 4-8 weeksWithout tenotomy: 4-8 weeks
– With tenotomy: 8- 16 weeksWith tenotomy: 8- 16 weeks
![Page 50: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/50.jpg)
Conclusion
The TEP is an efficient The TEP is an efficient method for the treatment of method for the treatment of
patients with apatients with a
Sportsman’s hernia Sportsman’s hernia
![Page 51: Prof. dr. C.H.J. van Eijck Afd. Heelkunde Sportershernia/plaatsen matje](https://reader036.vdocuments.site/reader036/viewer/2022062619/5516c675550346f0208b5afa/html5/thumbnails/51.jpg)
Dank voor jullie aandacht en veel
succes verder