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<v ->This is a 58 year old man

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I'm going to show you in a moment.

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And this gentleman was playing polo on a horse

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and had an injury, an acute injury

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and now groin pain and groin swelling.

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So, the history should really take you

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in a different descriptive mode

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rather than the sports hernia syndrome mode,

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which is really repetitive trauma

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in high performance athletes, under 35

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and certainly under 40 years of age.

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So he's not in the right demographic

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so how do we describe this?

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Well, let's start out with this diagram

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and I've shown you different appearances of sports hernias.

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I've showed you clefts that occur horizontally,

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I've shown you some oblique clefts that occur like this,

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I've even shown you some clefts that occur

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right off the midline.

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I've shown you some right where the rectus and the adductors

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meet each other in the prepubic plate,

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I've also shown you tears of the rectus abdominis,

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tears of the linea alba, and so on.

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You can see this is a very heterogeneous group

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of abnormalities that requires uber careful search.

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But when you have an acute injury

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and you rupture these structures here,

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this being the gracilis, there's the abductor longus,

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and here's the, pectineus off to the side,

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behind here is the adductor brevis,

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that's a different animal and the descriptors change.

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So let's have a look, shall we?

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So I have a coronal T1,

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an axial T2 fat suppression on the left

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and a coronal T2 fat suppression on the right.

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There's an obvious large fluid collection, which on T1,

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is hyperintense with methemoglobin standing, so it's blood.

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Now the key here is the descriptor.

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It would be culturally improper

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and probably medically improper to talk about this as a

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sports hernia syndrome for a few reasons.

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Patient's a little old. Usually under age 40.

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Second, it's an acute injury.

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So we're gonna just describe it as a

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myotendinous unit injury or avulsion of the adductor longus.

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We see the gracilis just medial to it.

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And then we're going to describe which muscles are involved.

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In this case, the adductor longus myotendinous unit

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is avulsed.

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We'll look at the axial to see

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if there's any involvement of muscles posterior to it.

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So let's work our way down.

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And there is, there's a little involvement

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of the abductor brevis.

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Is there involvement of

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the more lateral, pectineus?

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Relatively spared, a little bit of myoedema in it.

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And then we go into our axial projection.

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And if we've got an interstitial injury,

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we'll look and grade its severity,

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by seeing the defect, you know,

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I'm gonna draw a little circle of a muscle.

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So pretend it wasn't an avulsion,

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pretend it was an interstitial tear of the adductor longus

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and I'll break them down into defects

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less than or greater than five millimeters.

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If they're greater than five millimeters,

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then I go percent.

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Less than 25% cross-section, 25 to 50,

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or greater than 50.

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Then I also talk about length.

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Now when I measure length,

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in avulsion I'll measure where the stump is.

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If it's an interstitial tear,

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I'm going to measure the defect, not the edema

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I'll describe the edema and how extensive it is,

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but I'm looking for a defect

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in the myotendinous units, interstitially.

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And then I'll also comment on whether this has been a site

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of prior injury previously or not.

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So I don't use a numbered grading system

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so much as I am very descriptive

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in how a muscular injury has occurred.

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Whether the tendon is involved, whether it's avulsed,

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whether it has involved bone, whether there's separation

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of the muscle fibers from a central tendon,

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less than or greater than five millimeters,

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percent abnormality and cross-section, and length.

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That's how I attack a myotendinous unit acute injury.

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Let's move on, shall we?