Digital body mapping of pain quality and distribution in athletes with longstanding groin pain

Groin pain is common in athletes, but remains a challenge to diagnose. Self-reported pain quality distribution may facilitate differential diagnoses. We included 167 athletes with groin pain (≥ 4 weeks). All athletes received a standardized clinical examination. Athletes could choose multiple quality descriptors and intensity, and drew these on a digital body map. Overlay images were created to assess distribution and area visually. Intensity, duration, and qualities were compared between each clinical entity and multiple entities. Top three quality descriptors were electric (22%), pain (19%), and dull/aching (15%). There were no differences in the frequencies of quality descriptors (p = 0.893) between clinical entities. Areas of the mapped qualities were similar between the single clinical entities (χ(2)(3) = 0.143, p = 0.986) and independent of symptom duration (ρ = 0.004, p = 0.958). Despite a considerable overlap, the mapped pain qualities’ distributions appear to differ visually between single clinical entities and align with the defined clinical entities of adductor-related, inguinal-related, and pubic-related groin. In iliopsoas-related groin pain, pain extended more medially. The overlap between the drawn areas underscores a challenge in differentiating groin pain classifications based only on self-reported pain. The prevalence of pain quality descriptors varied and individually do not associate with one particular clinical entity of groin pain

Doha agreement meeting on terminology and definitions in groin pain in athletes.

BACKGROUND: Heterogeneous taxonomy of groin injuries in athletes adds confusion to this complicated area. AIM: The 'Doha agreement meeting on terminology and definitions in groin pain in athletes' was convened to attempt to resolve this problem. Our aim was to agree on a standard terminology, along with accompanying definitions. METHODS: A one-day agreement meeting was held on 4 November 2014. Twenty-four international experts from 14 different countries participated. Systematic reviews were performed to give an up-to-date synthesis of the current evidence on major topics concerning groin pain in athletes. All members participated in a Delphi questionnaire prior to the meeting. RESULTS: Unanimous agreement was reached on the following terminology. The classification system has three major subheadings of groin pain in athletes: 1. Defined clinical entities for groin pain: Adductor-related, iliopsoas-related, inguinal-related and pubic-related groin pain. 2. Hip-related groin pain. 3. Other causes of groin pain in athletes. The definitions are included in this paper. CONCLUSIONS: The Doha agreement meeting on terminology and definitions in groin pain in athletes reached a consensus on a clinically based taxonomy using three major categories. These definitions and terminology are based on history and physical examination to categorise athletes, making it simple and suitable for both clinical practice and research

Human matrix metalloproteinases: An ubiquitarian class of enzymes involved in several pathological processes

Human matrix metalloproteinases (MMPs) belong to the M10 family of the MA clan of endopeptidases. They are ubiquitarian enzymes, structurally characterized by an active site where a Zn(2+) atom, coordinated by three histidines, plays the catalytic role, assisted by a glutamic acid as a general base. Various MMPs display different domain composition, which is very important for macromolecular substrates recognition. Substrate specificity is very different among MMPs, being often associated to their cellular compartmentalization and/or cellular type where they are expressed. An extensive review of the different MMPs structural and functional features is integrated with their pathological role in several types of diseases, spanning from cancer to cardiovascular diseases and to neurodegeneration. It emerges a very complex and crucial role played by these enzymes in many physiological and pathological processes

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

MRI in chronic groin pain: sequence diagnostic reliability compared to systematic surgical assessment

International audienc

Digital body mapping of pain quality and distribution in athletes with longstanding groin pain

Groin pain is common in athletes, but remains a challenge to diagnose. Self-reported pain quality distribution may facilitate differential diagnoses. We included 167 athletes with groin pain (≥ 4 weeks). All athletes received a standardized clinical examination. Athletes could choose multiple quality descriptors and intensity, and drew these on a digital body map. Overlay images were created to assess distribution and area visually. Intensity, duration, and qualities were compared between each clinical entity and multiple entities. Top three quality descriptors were electric (22%), pain (19%), and dull/aching (15%). There were no differences in the frequencies of quality descriptors (p = 0.893) between clinical entities. Areas of the mapped qualities were similar between the single clinical entities (χ2(3) = 0.143, p = 0.986) and independent of symptom duration (ρ = 0.004, p = 0.958). Despite a considerable overlap, the mapped pain qualities’ distributions appear to differ visually between single clinical entities and align with the defined clinical entities of adductor-related, inguinal-related, and pubic-related groin. In iliopsoas-related groin pain, pain extended more medially. The overlap between the drawn areas underscores a challenge in differentiating groin pain classifications based only on self-reported pain. The prevalence of pain quality descriptors varied and individually do not associate with one particular clinical entity of groin pain

Novel Use of Botulinum Toxin in Long-Standing Adductor-Related Groin Pain: A Case Series

BACKGROUND: Adductor-related groin pain (ARGP) is the most common groin injury in athletes. If conservative treatment fails, then adductor tenotomy to relieve tension can be considered. The use of botulinum toxin A (BoNT-A) has shown good results in other musculoskeletal pathologies. OBJECTIVE: Assess the effectiveness of BoNT-A injections in ARGP in cases where usual treatment has failed. DESIGN: Retrospective cohort study. SETTING: Orthopedic Medicine and Rehabilitation Unit, University of Bordeaux. PARTICIPANTS: Fifty patients treated by BoNT-A injection in ARGP after failure of medical and/or surgical treatment were included in this study. INTERVENTIONS: One or several adductor muscles were injected with BoNT-A, according to clinical evaluation using ultrasound and electrical stimulation guidance. Patients were followed up at 1, 3, 6, and 12 months. MAIN OUTCOME MEASURES: The primary assessment criterion was the improvement of Hip and Groin Outcome Score subscales at day 30. Secondary outcomes included pain intensity and impact on sport, work, and quality of life (QoL), the Blazina scale, and side effects. RESULTS: All the first 50 injected patients (45 male and 5 female patients) were included. A significant improvement was noted regarding the majority of Hip and Groin Outcome Score subscales at day 30 (P < 0.05). Pain intensity and its impacts were both significantly reduced (P < 0.001): less sport and professional disability and lower impact on QoL. Severity of symptoms assessed by the Blazina scale was significantly reduced (P < 0.001). The improvements remained significant until 1-year postinjection. CONCLUSIONS: BoNT-A is promising as a new treatment for ARGP but should be fully assessed in a randomized controlled trial