Chronic groin pain in athletes is often difficult to diag nose and treat. There are many anatomic structures in the inguinal and groin region that have the potential to cause pain. We report 32 cases of a previously unde scribed condition in athletes of "obturator neuropathy," a fascial entrapment of the obturator nerve where it enters the thigh. This condition represents a type of groin pain in athletes that is treatable by surgical means. There is a characteristic clinical pattern of ex ercise-induced medial thigh pain commencing in the region of the adductor muscle origin and radiating dis tally along the medial thigh. Needle electromyography demonstrates denervation of the adductor muscles. Surgical neurolysis treatment provides the definitive cure of this problem, with athletes returning to compe tition within several weeks of treatment. The surgical findings are entrapment of the obturator nerve by a thick fascia overlying the short adductor muscle. The role of conservative treatment in the management of this condition is unknown at present.
Get full access to this article
View all access options for this article.
References
1.
Brukner P., Khan KM Clinical Sports Medicine Sydney, McGraw-Hill, 1993, pp 302-315
2.
Charkes ND, Siddhivarn N., Schneck CD Bone scanning in the adductor insertion avulsion syndrome ("thigh splints") J Nucl Med281835-1838, 1987
3.
Clark Jmp: Obstetrical palsy J Bone Joint Surg47B806, 1965
4.
Delagi EF, Perotto A. Anatomic Guide for the Electromyographer Second edition Springfield, Charles C Thomas Publishers, 1980
5.
Ekberg O., Persson NH, Abrahamsson PA: Longstanding groin pain in athletes A multidisciplinary approach. Sports Med656-61, 1988
6.
Felsenthal G. Nerve blocks in the lower extremities Anatomical considerations Arch Med Phys Rehabil55504-507, 1974
7.
Fricker PA, Taunton JE, Ammann W. Osteitis pubis in athletes Infection, inflammation or injury? Sports Med12266-279, 1991
8.
Gerlach UJ, Lierse W. Functional construction of the superficial and deep fascia system of the lower limb in man Acta Anat13911-25, 1990
Katritsis E. , Anagnostopoulou S., Papadopoulos N. Anatomical observations in the accessory obturatory nerve (based on 1000 specimens) Anat Anz148140-145, 1980
11.
Kelly M. Some rules for the employment of local analgesia in the treatment of somatic pain Med J Aust1235-239, 1947
12.
Kopell HP, Thompson W. Peripheral entrapment neuropathies of the lower extremity N Eng J Med26256, 1960
13.
Kopell HP, Thompson WA, Postell AH Entrapment neuropathy of the ilioinguinal nerve. New Eng J Med26616-19, 1962
14.
Kozlowski JM , Beal JM Obturator hernia. An elusive diagnosis Arch Surg1121001-1002,1977
15.
Larrieu AJ, De Marco SJ Obturator hernia Report of a case and brief review of its status Am Surg42273-277, 1976
16.
Leno C., Combarros O., Polo JM, et al Bilateral obturator neuralgia secondary to osteitis of the pubis Arch Neurobiol47347-352, 1984
17.
Lolic-Draganic V., Ilic A. Obturator nerve Acta Orthop Lugosl3361-363, 1972
18.
Long C. Myofascial pain syndromes Henry Ford Hosp Med Bull4102-106, 1956
19.
Lovell G. The diagnosis of chronic groin pain in athletes An evaluation of 189 cases Aust J Sci Med Sport2776-79, 1995
20.
Magora F., Rozin R., Ben-Menachem Y., et al Obturator nerve block. An evaluation of technique. Br J Anaesth41. 695-698, 1969
21.
Martens MA, Hansen L., Mulier JC: Adductor tendonitis and musculus rectus abdominus tendonopathy. Am J Sports Med15: 353-356, 1987
Siliski JM, Scott RD: Obturator nerve palsy resulting from intra-pelvic extrusion of cement during total hip replacement. Report of four cases J Bone Joint Surg67A: 1225-1230, 1985
33.
Simons DG Myofascial pain syndrome due to trigger points, in Goodgold J (ed): Rehabilitation Medicine. St Louis, CV Mosby Co, 1988, pp 686-723
34.
Somell A., Ljungdahl I., Spangen L.: Thigh neuralgia as a symptom of obturator hernia. Acta Chir Scand142: 457-459, 1976
35.
Susens GP, Hendrikson CG, Mulder J., et al Femoral nerve entrapment secondary to a heparin hematoma Ann Intern Med69: 575-579, 1968
36.
Travell J., Simons DG: Myofascial Pain and Dysfunction: Volume 2 The Lower Extremities. Baltimore, Williams & Wilkins, 1992, pp 289-314
37.
Warwick R, Williams RL (eds) Gray's Anatomy. Thirty-fifth edition Edinburgh, Longman Group Publishers, 1973, pp 1052-1053
38.
Weber ER, Daube JR, Coventry MB: Peripheral neuropathies associated with total hip arthroplasty. J Bone Joint Surg58A: 66-69, 1976
