AANA Lab Course 914 - Advanced Hip Arthroscopy-Athletic Groin Injuries and Surgical Indications, Srino Bharam, MD

Athletic Groin Injuries and Surgical Indications, Srino Bharam, MD

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This document summarizes a presentation by Dr. Srino Bharam at the AANA Hip Course 914 held in November 2019 at the Orthopaedic Learning Center in Rosemont. Dr. Bharam, a Clinical Professor and Hip Preservation Director, discussed the clinical assessment and imaging of hip and groin injuries, focusing on injuries around the pubic symphysis and the adductor muscle group.<br /><br />Key topics include various types of groin and hip-related injuries classified by their anatomical location relative to the symphysis pubis: above, at the level of, and below the symphysis. Injuries discussed above the symphysis involve inguinal disruption, rectus abdominis strains, ilioinguinal nerve entrapment, and adductor musculotendinous injuries. At the symphysis level, conditions include pubic rami stress fractures, adductor avulsion, and enthesopathy. Below the symphysis also involves similar injury types.<br /><br />The presentation emphasized clinical evaluation techniques such as inspection, palpation, provocative strength testing (e.g., resisted adduction, extension, flexion, and resisted sit-up), and sensory exams, highlighting the importance of groin exams in addition to hip assessment.<br /><br />Imaging, particularly dedicated pelvic MRI with axial oblique and sagittal views, is critical for accurate diagnosis. The lecture referenced several studies by Schilders et al. (2017) detailing the disruption of muscle complexes such as displacement of pyramidalis and proximal adductors in injuries.<br /><br />Dr. Bharam illustrated acute and repetitive injury mechanisms, including avulsions, strains, tendinopathy, and contractures, with case examples such as a 32-year-old marathon trainee and a 17-year-old lacrosse player.<br /><br />Overall, the presentation advocated for an anatomical and systematic approach combining detailed history, physical exam, and advanced imaging to diagnose complex hip and groin injuries associated with athletic activity.

Keywords

Hip injuries

Groin injuries

Pubic symphysis

Adductor muscle injuries

Clinical assessment

Pelvic MRI

Muscle strains

Avulsion injuries

Athletic injuries

Physical examination