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Athletic Pubalgia Surgery Wrecks a Life

POSTED ON IN Hip Latest News BY Chris Centeno

athletic pubalgia surgery

“I tell you Boris, that one of these days we’ll look in to our microscope and find ourselves staring right into God’s eyes, and the first one who blinks is going to lose his testicles.”-Harry Wolper

Early on in my career, I had my first brush with what I now call a “Disturbingly Dumb Surgery”. I was a young doctor interviewing a patient with groin pain which was obviously caused by a pinched nerve in his back. He proceeded to tell me that a local urologist had decided that a way to fix that issue was to remove his testicles. The patient said it nonchalantly, as if having testicles taken out was as common as having tonsils removed. I audibly gasped. My reaction was followed by me uncontrollably saying, “They did what?”, which became my standard for classifying a surgery as “Disturbingly Dumb” (DD).

To provide some context for DD surgeries, one recent entry to my list is called PAO hip surgery. In 2012, I first saw a patient who had his pelvis chopped off to realign his hip, which is an apt description for this barbaric procedure. I’ve since seen several patients who have had their lives ruined by this surgery. One patient is still bedridden, many years after the procedure, due to the fact that the part of the pelvis they chopped off never rejoined the rest of the body, leaving her leg permanently disconnected.

Athletic Pubalgia Surgery Joins the Disturbingly Dumb Surgery List

This week I came across another “gasp-out-loud” story centered around the hip and groin area. This patient had the surgery when she was just 15 years old for “athletic pubalgia”, which is an old time medical/Latin term for groin pain due to sports. She told me that a surgeon “released” her abdominal and adductor muscles (which means cutting many lines in and trying to lengthen the tendons) in what was described as athletic pubalgia surgery. She woke up from the procedure with horrible burning pain from damaged ilioinguinal nerves and a nerve that went to her thigh. Not only did the original pain not improve, but she also now has severe chronic nerve pain that prevents her from wearing certain types of clothing and prevents activity. She’s now in her late 20s and can’t hold a job or do many of the things we all take for granted. We’re hopeful that we can help her through this using platelet lysate nerve hydrodissection, which involves precisely injecting the growth factors from her blood platelets around the damaged nerve under ultrasound guidance. As I discussed with her yesterday, we can begin with the femoral cutaneous nerve to her thigh as a proof of concept, as I don’t want to repeat the “bull in a china shop” behavior that brought her here in the first place.

The hard part about this case for me is that if you find the right doctor “athletic pubalgia” can be easily fixed through injections of platelet rich plasma into adductor tendons and the symphysis pubis, without the need for surgery, cutting nerves, rearranging muscles, and so on. In addition, there’s usually a bio mechanical cause, like an unstable SI joint that has to be recognized and worked on in tandem. Even more disheartening, is that back when she had this surgery, there was a doctor across town in Philadelphia who could have treated this with prolotherapy with a high success rate.

As Interventional Orthopedics takes off, we need to do away with these Disturbingly Dumb surgeries that are fueled by the hubris that we doctors can easily rearrange the body’s parts. Regrettably for patients, trying to lengthen tendons that are fine-tuned to micro-millimeter precision, using surgeries that have a healing accuracy of centimeters, is a recipe for disaster and sets otherwise healthy individuals up for a life of misery. So here’s to the future and no more lost testicles!

    comments

    Bridgette says

    "Being pain free takes personal effort and commitment. It doesn't come from a pill bottle, a surgeon's knife, a brace, or in specially designed mattress, chairs, and tools." A quote I like from the book, "Pain Free A Revolutionary Method For Stopping Chronic Pain," by Pete Egoscue.

    A particular attitude needs to be made in today's world of medicine, towards your body and come to a true understanding the importance of how things work and function. Educate yourself before doing something that could end up on, what is surely one heck of a massive list of "Disturbingly Dumb" Surgeries.

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    Regenexx Team says

    Bridgette,
    100% in agreement!

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    Dan Timpert says

    my name is Dan Timpert from Dunellen N.J. In2009 i had laproscopic sports hernia surgery using mess to reinforce the muscles. The pain relief lasted for about 1 year then returned intermitantley, now persistent. im looking for a doctor that does platelet lysate nerve hydrodissection in N.J.Trying to avoid another surgery.

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    Regenexx Team says

    Dan,

    Seeing someone to perform an ultrasound of this area to see if it healed and if not, trying some PRP would likely be a good place to start. Dr. Kramberg, one of our Regenexx providers in NJ, may be able to help with that. http://www.rehabmd.com/

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    Chris Centeno says

    Dan, if the pain has returned, it sounds like you may want to have a physician perform an ultrasound exam to see if the tissues are still together. If there's still a small tear, then a precise PRP injection under guidance may help.

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    Matthew Schneider says

    Having meet with Dr. Meyers a leader in Athletic Pubalgia Surgery I am at a loss as I cannot find anyone other than Dr. Meyers that will even discuss treatment. I have seen 5 doctors and then referred to Dr. Meyers. I cannot afford the procedure which is 14,000 and not covered under any insurance, but who do I turn to for treatment? PT is not working, rest does nothing? I live in Upstate NY, Binghamton NY. Any advice would be greatly appreciated.

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    Regenexx Team says

    Matthew,
    Athletic Pubalgia can be treated with platelet lysate nerve hydrodissection, which involves precisely injecting the growth factors from your blood platelets around the damaged nerve under ultrasound guidance. While none in Binghamton, NY, there are several Regenexx Providers in the general area: http://www.regenexx.com/find-a-physician/

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    Itzhak Kadosh says

    Hello Regenexx!
    Im injured for about 9 months and recently an expert ( called Moshe Dudai ) said that I have Sportsman Hernia and that I need to undergo Endoscopic surgery so I can return to activaity. Now I trust Regenexx because for a while now I searched about orthopedic problems and saw for exemple that orthopedic surgery for meniscus tear may be just cutting a part of the meniscus which was very not solution in my mind for people with meniscus problems , and then I found Regenexx and saw the Regenexx webiner and I saw that in Regenexx people actually gets appropriate solutions and that Regenexx think the same I do and also that in Regenexx theres a wide knoledge on different problems. So I am asking for your opinion on if I should undergo the surgery and if its the only solution for me. I can send you the observation the expert wrote in english. Im scared I will scraw up the few chances that I now may have to return to the life I had pre-injury , im afraid that the surgery will ruin my life..
    Also the expert said that there is Pubic Stress Injury caused because the Sportsman Hernia and after the surgery a 8 weeks physical therapy will get me back to activaty hopefully.

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    Regenexx Team says

    Itzhak,
    You are correct, there is an injection based alternative to this often damaging surgery. Do you have a recent MRI? Where are you located? Please submit the Candidate form so we can see if you'd be a Candidate for this procedure: https://www.regenexx.com/athletic-pubalgia-surgery/

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    About the Author

    Chris Centeno

    Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…

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