Unverzagt Casey A, Schuemann Teresa, Mathisen Jeffrey
Skyline Hospital Physical Therapy and Sports Medicine, White Salmon, WA, USA.
J Orthop Sports Phys Ther. 2008 Feb;38(2):63-70. doi: 10.2519/jospt.2008.2626. Epub 2007 Sep 7.
Resident's case problem.
Chronic anterior hip and groin pain is a growing concern among high-performance athletes. This manuscript enforces the need for physical therapists to remain current with its complex differential diagnosis, as it can be debilitating for the athlete and equally frustrating for the sports medicine team. This resident's case problem details the account of an 18-year-old high-school wrestler who presented to the high-school sports medicine team without physician referral. His chief complaint was chronic right anterior hip and groin pain, which had been variable in frequency and intensity for 3 years.
A screening examination for serious underlying pathology was negative. After physical examination, it was determined that this individual had signs and symptoms consistent with a sports hernia. He was referred to a general surgeon who diagnosed him with a symptomatic inguinal hernia and later performed laparoscopic evaluation and treatment. The patient had a moderate-size indirect inguinal hernia sac, which was carefully dissected away from the remaining contents of the spermatic cord and was repaired with a Parietex mesh. At a 2-week postoperation follow-up, the patient was asymptomatic and cleared to return to wrestling and baseball without limitations.
This resident's case problem demonstrates the debilitating and often elusive nature of a sports hernia. It suggests that the diagnosis is not well understood and emphasizes the importance of a robust medical foundation for each member of the sports medicine team conducting athletic evaluations.
住院医师病例问题。
慢性前髋部和腹股沟疼痛在高水平运动员中日益受到关注。本手稿强调了物理治疗师跟上其复杂鉴别诊断的必要性，因为这对运动员可能造成衰弱，对运动医学团队也同样令人沮丧。该住院医师病例问题详细描述了一名18岁高中摔跤运动员的情况，他未经医生转诊就来到了高中运动医学团队。他的主要诉求是右髋部和腹股沟慢性疼痛，3年来频率和强度不一。
对严重潜在病理的筛查检查结果为阴性。体格检查后，确定该患者有与运动疝相符的体征和症状。他被转诊给一名普通外科医生，该医生诊断他患有症状性腹股沟疝，随后进行了腹腔镜评估和治疗。患者有一个中等大小的间接腹股沟疝囊，小心地从精索的其余内容物中分离出来，并用Parietex补片进行修复。术后2周随访时，患者无症状，获准无限制地恢复摔跤和棒球运动。
该住院医师病例问题展示了运动疝的衰弱性且往往难以捉摸的性质。这表明其诊断尚未得到很好的理解，并强调了对进行运动评估的运动医学团队每个成员建立坚实医学基础的重要性。
