AANA Lab Course 914 - Advanced Hip Arthroscopy-Groin Exam and Anatomical Consideration, Srino Bharam, MD

Groin Exam and Anatomical Consideration, Srino Bharam, MD

Pdf Summary

This document summarizes key concepts from the AANA HIP COURSE 914 held in November 2019, focusing on hip and groin injuries relevant to orthopaedic surgery and hip preservation. Dr. Srino Bharam, a Clinical Professor and Director of Hip Preservation, presented on common pathologies associated with groin and pelvic pain, their diagnosis, and imaging techniques.<br /><br />The presentation highlights different injury locations relative to the pubic symphysis, categorizing conditions as occurring above, at, or below this anatomical landmark. Above the symphysis, common diagnoses include inguinal disruption, rectus abdominis injuries, and nerve entrapments such as ilioinguinal and obturator nerves. At the level of the symphysis, pubic rami stress fractures, adductor avulsions, and enthesopathies are noted. The importance of correlating symptoms like point tenderness and pain with resisted adduction for clinical diagnosis is emphasized.<br /><br />Anatomically, the adductor muscle group—longus, brevis, and magnus—is discussed, with adductor longus having the least mechanical advantage in hip adduction. Mechanically, trunk hyperextension combined with thigh abduction generates shear forces across the pubic symphysis, contributing to injury. Various injury types include acute avulsions and strains, repetitive inguinal disruptions, tendinopathies, and contractures, with examples from athletes like marathon runners and lacrosse players.<br /><br />Clinical evaluation involves thorough inspection, palpation, provocative strength tests (resisted adduction, extension, flexion, resisted sit-ups), and sensory examination, all part of a systematic groin and hip exam. Dedicated MRI of the pelvis using axial oblique and sagittal views is crucial for accurate diagnosis.<br /><br />The approach advocates for combining detailed clinical assessment with targeted imaging to effectively identify and treat complex groin and hip pathologies, enhancing patient outcomes in both athletic and general populations.

Keywords

AANA HIP COURSE 914

hip and groin injuries

orthopaedic surgery

hip preservation

pubic symphysis

inguinal disruption

adductor muscle group

clinical diagnosis

MRI pelvis imaging

groin and hip examination