Athletic Pubalgia Surgery Wrecks a Life
POSTED ON 12/3/2015 IN Research BY Christopher Centeno
"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!
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