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The most common symptoms of RLP are:
- Sudden pain in the lower abdomen, usually in the right side of the pelvic area that can extend to the groin.
- Shooting abdominal pain when performing sudden movements or physical exercise. Pain is sudden, intermittent and lasts only for a few seconds.
Round ligament pain (RLP) is pain associated with the round ligament of the uterus, usually during pregnancy. RLP is one of the most common discomforts of pregnancy and usually starts at the second trimester of gestation and continues until delivery. It usually resolves completely after delivery although cases of postpartum RLP (that is, RLP that persisted for a few days after delivery) have been reported. RLP also occurs in nonpregnant women.
The round ligament of the uterus goes from the pelvis, passes through the internal abdominal ring, and runs along the inguinal canal to the labia majora. It is the structure that holds the uterus suspended inside the abdominal cavity. There are at least 2 other round ligaments in the human body, the round ligament of the liver ("ligamentum teres hepatis") and the round ligament of the head of the femur ("ligamentum teres femoris").
Pelvic girdle pain is complex and multi-factorial and likely to be represented by a series of sub-groups with different underlying pain drivers from peripheral or central nervous system, altered laxity/stiffness of muscles, laxity to injury of tendinous/ligamentous structures to 'mal-adaptive' body mechanics. Musculo-skeletal mechanics involved in gait and weightbearing activities can be mild to grossly impaired. PGP can begin peri or postpartum. Land or water based exercise may help prevent and treat lower back and pelvic pain but research on this subject is low quality. There is pain, instability or dysfunction in the symphysis pubis and/or sacroiliac joints. Moderate-quality evidence from a systematic review suggest that exercise or acupuncture reduced pelvic pain or lumbo-pelvic pain more than usual care.
Occurs in between an estimated 21% to 62% of cases, possibly due to edema.
Symptoms of a rupture may be initially quite subtle. An old cesarean scar may undergo dehiscence; but with further labor the woman may experience abdominal pain and vaginal bleeding, though these signs are difficult to distinguish from normal labor. Often a deterioration of the fetal heart rate is a leading sign, but the cardinal sign of uterine rupture is loss of fetal station on manual vaginal exam. Intra-abdominal bleeding can lead to hypovolemic shock and death. Although the associated maternal mortality is now less than one percent, the fetal mortality rate is between two and six percent when rupture occurs in the hospital.
In pregnancy uterine rupture may cause a viable abdominal pregnancy. This is what accounts for most abdominal pregnancy births.
- Abdominal pain and tenderness. The pain may not be severe; it may occur suddenly at the peak of a contraction. The woman may describe a feeling that something "gave way" or "ripped."
- Chest pain, pain between the scapulae, or pain on inspiration—Pain occurs because of the irritation of blood below the woman's diaphragm
- Hypovolemic shock caused by haemorrhage— Falling blood pressure, tachycardia, tachypnea, pallor, cool and clammy skin, and anxiety. The fall in blood pressure is often a late sign of haemorrhage
- Signs associated with fetal oxygenation, such as late deceleration, reduced variability, tachycardia, and bradycardia
- Absent fetal heart sounds with a large disruption of the placenta; absent fetal heart activity by ultrasound examination
- Cessation of uterine contractions
- Palpation of the fetus outside the uterus (usually occurs only with a large, complete rupture). The fetus is likely to be dead at this point.
- Signs of an abdominal pregnancy
- Post-term pregnancy
Uterine rupture is a serious event during childbirth by which the integrity of the myometrial wall is breached. In an incomplete rupture the peritoneum is still intact. With a complete rupture the contents of the uterus may spill into the peritoneal cavity or the broad ligament. A uterine rupture is a life-threatening event for mother and baby.
A uterine rupture typically occurs during active labor, but may also develop during late pregnancy.
Uterine dehiscence is a similar condition, but involves fewer layers, less bleeding, and less risk.
The uterus (womb) is normally held in place by a hammock of muscles and ligaments. Prolapse happens when the ligaments supporting the uterus become so weak that the uterus cannot stay in place and slips down from its normal position. These ligaments are the round ligament, uterosacral ligaments, broad ligament and the ovarian ligament. The uterosacral ligaments are by far the most important ligaments in preventing uterine prolapse.
The most common cause of uterine prolapse is trauma during childbirth, in particular multiple or difficult births. About 50% of women who have had children develop some form of pelvic organ prolapse in their lifetime. It is more common as women get older, particularly in those who have gone through menopause. This condition is surgically correctable.
Uterine prolapse is a form of female genital prolapse. It is also called pelvic organ prolapse or prolapse of the uterus (womb).
Risk factors for uterine prolapse include pregnancy, childbirth, chronic increases in intra-abdominal pressure such as lifting, coughing or straining, connective tissue conditions, and damage to or weakness of the muscles.
Treatment may be conservative or surgical and should be based upon patient symptoms and preference.
Secondary hydroceles due to testicular diseases can be the result of cancer, trauma (such as a hernia), or orchitis (inflammation of testis), and can also occur in infants undergoing peritoneal dialysis. A hydrocele is not a cancer but it should be excluded clinically if a presence of a testicular tumor is suspected, however, there are no publications in the world literature that report a hydrocele in association with testicular cancer. Secondary hydrocele is most frequently associated with acute or chronic epididymo-orchitis. It is also seen with torsion of the testis and with some testicular tumors. A secondary hydrocele is usually lax and of moderate size: the underlying testis is palpable. A secondary hydrocele subsides when the primary lesion resolves.
- Acute/chronic epididymo-orchitis
- Torsion of testis
- Testicular tumor
- Hematocele
- Filarial hydrocele
- Post herniorrhaphy
- Hydrocele of an hernial sac
Symptoms include: pain on weight bearing, frequently after only a short time. The nature of the pain varies widely among individuals. Some people experience shooting pain affecting the contiguous halves of two toes. Others describe a feeling like having a pebble in their shoe or walking on razor blades. Burning, numbness, and paresthesia may also be experienced. The symptoms progress over time, often beginning as a tingling sensation in the ball of the foot.
Morton's neuroma lesions have been found using MRI in patients without symptoms.
It can, however, grow to almost 10 cm (4 inches) in diameter and has the potential to bleed into itself or twist the ovary, causing pelvic or abdominal pain. If it fills with blood, the cyst may rupture, causing internal bleeding and sharp pain. This pain disappears within a few days of the rupture. Rarely, it may cause the ovary to twist around the ovarian ligament and can cut off the blood flow to the ovary. This is known as ovarian torsion and causes pain and other symptoms.
In infants and children, a hydrocoele is usually an expression of a patent processus vaginalis (PPV). The tunica and the processus vaginalis are distended to the inguinal ring but there is no connection with the peritoneal cavity.Getting above swelling is not possible.
Symptoms include pain during sports movements, particularly hip extension, and twisting and turning. This pain usually radiates to the adductor muscle region and even the testicles, although it is often difficult for the patient to pin-point the exact location.
Following sporting activity the person with athletic pubalgia will be stiff and sore. The day after a match, getting out of bed or a car will be difficult. Any exertion that increases intra-abdominal pressure, such as coughing, sneezing, or sporting activity can cause pain. In the early stages, the person may be able to continue playing their sport, but the problem usually gets progressively worse.
As pain in the groin and pelvis can be referred from a number of problems, including injuries to the lumbar spine, the hip joint, the sacro-iliac joint, the abdomen, and the genito-urinary system, diagnosis of athletic pubalgia requires skillful differentiation and pubic examination in certain cases where there is intense groin pain.
The diagnosis is based on the patient's history, clinical signs, and, increasingly, an MRI exam. Symptoms can often be reproduced by maneuvers such as performing sit-ups or crunches. Pain can also be elicited with the patient in a "frog position," in which the patient is supine with knees bent and heels together.
The exact lesion may differ, but common pathologic findings at operation are:
- torn external oblique aponeurosis
- tear in the conjoint tendon
- conjoint tendon torn from pubic tubercle
- dehiscence between conjoined tendon and inguinal ligament
- tear in the fascia transversalis
- abnormal insertion of the rectus abdominis muscle
- tear of the abdominal internal oblique muscle from the pubic tubercle
- entrapment of the ilioinguinal nerve or genitofemoral nerve
Several of these lesions may occur simultaneously. Also, many athletes have concomitant weakness or tearing of the adductor muscles or labral tears of the hip.
When the adductor muscles are tight post injury, that can be enough to trigger symptoms. The first conservative treatment option should be to restore normal motion after the adductor has begun to heal (usually 6–8 weeks post injury). Sleeping in a prone position with the hip on the affected side flexed and externally rotated can be a cure in some individuals.
The exact incidence of these entities is unknown: some believe it is the most common cause of chronic groin pain in athletes, while others argue that it is only rare. Conservative therapies (gentle stretching and a short period of rest) may temporarily alleviate the pain, but definitive treatment consists of surgical repair followed by a structured rehabilitation.
Chilaiditi syndrome is a rare condition when pain occurs due to transposition of a loop of large intestine (usually transverse colon) in between the diaphragm and the liver, visible on plain abdominal X-ray or chest X-ray.
Normally this causes no symptoms, and this is called Chilaiditi's sign. The sign can be permanently present, or sporadically. This anatomical variant is sometimes mistaken for the more serious condition of having air under the diaphragm (pneumoperitoneum) which is usually an indication of bowel perforation, possibly leading to surgical interventions.
Chilaiditi syndrome refers only to complications in the presence of Chilaiditi's sign. These include abdominal pain, torsion of the bowel (transverse colon volvulus) or shortness of breath.
A Corpus luteum cyst is a type of ovarian cyst which may rupture about the time of menstruation, and take up to three months to disappear entirely. A corpus luteum cyst rarely occurs at age 50+, because eggs are no longer being released in menopausal women. Corpus luteum cysts may contain blood and other fluids. The physical shape of a corpus luteum cyst may appear as an enlargement of the ovary itself, rather than a distinct mass -like growth on the surface of the ovary.
The condition is usually seen in athletic individuals typically between 10–14 years of age. Following a strain or partial rupture of patellar ligament the patient develops a traction ‘tendinitis’ characterized by pain and point tenderness at the inferior (lower) pole of the patella associated with focal swelling.
Children with cerebral palsy are particularly prone to SLJ 4.
There are no specific clinical signs or complementary test results for this condition. The typical symptoms of PNE or PN are seen, for example, in male competitive cyclists (it is often called "cyclist syndrome"), who can rarely develop recurrent numbness of the penis and scrotum after prolonged cycling, or an altered sensation of ejaculation, with disturbance of micturition (urination) and reduced awareness of defecation. Nerve entrapment syndromes, presenting as genitalia numbness, are amongst the most common bicycling associated urogenital problems.
The pain is typically caused by sitting, relieved by standing, and is absent when recumbent (lying down) or sitting on a toilet seat. If the perineal pain is positional (changes with the patient's position, for example sitting or standing), this suggests a tunnel syndrome. Anesthesiologist John S. McDonald of UCLA reports that sitting pain relieved by standing or sitting on a toilet seat is the most reliable diagnostic parameter.
Other than positional pain and numbness, the main symptoms are fecal incontinence and urinary incontinence.
Differential diagnosis should consider the far commoner conditions chronic prostatitis/chronic pelvic pain syndrome and interstitial cystitis.
Athletic pubalgia, also called sports hernia, hockey hernia, hockey groin, Gilmore's Groin, or groin disruption is a medical condition of the pubic joint affecting athletes.
It is a syndrome characterized by chronic groin pain in athletes and a dilated superficial ring of the inguinal canal. Football and ice hockey players are affected most frequently, and both recreational and professional athletes may be affected.
Patients with MALS reportedly experience abdominal pain, particularly in the epigastrium, which may be associated with eating and which may result in anorexia and weight loss.The pain can be in the left or right side, but usually where the ribs meet. Other signs are persistent nausea, lassitude (especially after a heavy meal) and exercise intolerance. Diarrhea is a common symptom, some experience constipation. While some experience vomiting, not everyone does. Exercise or certain postures can aggravate the symptoms. Occasionally, physical examination reveals an abdominal bruit in the mid-epigastrium.
Complications of MALS result from chronic compression of the celiac artery. They include gastroparesis and aneurysm of the pancreaticoduodenal arteries.
Morton's neuroma (also known as Morton neuroma, Morton's metatarsalgia, Intermetatarsal neuroma and Intermetatarsal space neuroma.) is a benign neuroma of an intermetatarsal plantar nerve, most commonly of the second and third intermetatarsal spaces (between 2nd−3rd and 3rd−4th metatarsal heads), which results in the entrapment of the affected nerve. The main symptoms are pain and/or numbness, sometimes relieved by removing narrow or high-heeled footwear. Sometimes symptoms are relieved by wearing non-constricting footwear.
Some sources claim that entrapment of the plantar nerve because of compression between the metatarsal heads, as originally proposed by Morton, is highly unlikely, because the plantar nerve is on the plantar side of the transverse metatarsal ligament and thus does not come in contact with the metatarsal heads. It is more likely that the transverse metatarsal ligament is the cause of the entrapment.
Despite the name, the condition was first correctly described by a chiropodist named Durlacher, and although it is labeled a "neuroma", many sources do not consider it a true tumor, but rather a perineural fibroma (fibrous tissue formation around nerve tissue).
The exact cause is not always known, but it may occur in patients with a long and mobile colon (dolichocolon), chronic lung disease such as emphysema, or liver problems such as cirrhosis and ascites. Chilaiditi's sign is generally not associated with symptoms, and is most commonly an incidental finding in normal individuals.
Absence or laxity of the ligament suspending the transverse colon or of the falciform ligament are also thought to contribute to the condition. It can also be associated with relative atrophy of the medial segment of the left lobe of the liver. In this case, the gallbladder position is often anomalous as well – it is often located anterior to the liver, rather than posterior.
A strain is a type of acute injury that occurs to the muscle or tendon. Similar to sprains, it can vary in severity, from a stretching of the muscle or tendon to a complete tear of the tendon from the muscle. Some of the most common places that strains occur are in the foot, back of the leg (hamstring), or back.
A contusion is the discoloration of the skin, which results from underlying muscle fibers and connective tissue being crushed.This can happen in a variety of ways such as a direct blow to the skin, or a fall taken against a hard surface.The discoloration in the skin is present when blood begins to pool around the injury.
Sinding-Larsen and Johansson syndrome, named after Swedish surgeon Sven Christian Johansson (1880-1959), and Christian Magnus Falsen Sinding-Larsen (1866-1930), a Norwegian physician, is an analogous condition to Osgood–Schlatter disease involving the patellar tendon and the lower margin of the patella bone, instead of the upper margin of the tibia, as is the case in Osgood-Schlatter. This variant was discovered in 1908, during a winter indoor Olympic qualifier event in Scandinavia. Sever's disease is a similar condition affecting the heel.
This condition called Sinding-Larsen and Johansson syndrome was described independently by Sinding-Larsen in 1921 and Johansson in 1922.
Fibroids that lead to heavy vaginal bleeding lead to anemia and iron deficiency. Due to pressure effects gastrointestinal problems such as constipation and bloatedness are possible. Compression of the ureter may lead to hydronephrosis. Fibroids may also present alongside endometriosis, which itself may cause infertility. Adenomyosis may be mistaken for or coexist with fibroids.
In very rare cases, malignant (cancerous) growths, leiomyosarcoma, of the myometrium can develop. In extremely rare cases uterine fibroids may present as part or early symptom of the hereditary leiomyomatosis and renal cell cancer syndrome.