Non-surgical treatment of pubic overload and groin pain in amateur football players: a prospective double-blinded randomised controlled study.

PURPOSE: The incidence of groin pain in athletes is steadily increasing. Symptomatic pubic overload with groin pain and aseptic osteitis pubis represent well-known and frequently misdiagnosed overuse injuries in athletes. This study investigated the benefits of standardised non-surgical treatment for swift return-to-football. METHODS: In a prospective double-blinded controlled study, 143 amateur football players with groin pain as well as radiological signs and clinical symptoms of pubic overload were analysed for 1 year. Two randomised study groups participated in an intensive physical rehabilitation programme, either with or without shock wave therapy. The control group did not participate in any standardised rehabilitation programme but only stopped participating in sports activity. Follow-up examinations took place 1, 3 months and 1 year after the beginning of therapy. Endpoints were visual analogue scale (VAS), functional tests, the time of return-to-football, recurrent complaints and changes in the MR image. RESULTS: Forty-four football players with groin pain and aseptic osteitis pubis were randomised into two study groups; 26 received shock wave therapy, 18 did not. Clinical examination showed pubic overload as a multi-located disease. Players receiving shock wave therapy showed earlier pain relief in the VAS (p < 0.001) and returned to football significantly earlier (p = 0.048) than players without this therapy. Forty-two of 44 players of both study groups returned to football within 4 months after the beginning of therapy and had no recurrent groin pain within 1 year after trauma. Fifty-one players of the control group returned to football after 240 days (p < 0.001), of whom 26 (51%) experienced recurrent groin pain. Follow-up MRI scans did not show any effect of shock wave therapy. CONCLUSION: Non-surgical therapy is successful in treating pubic overload and osteitis pubis in athletes. Shock wave therapy as a local treatment significantly reduced pain, thus enabling return-to-football within 3 months after trauma. Early and correct diagnosis is essential for successful intensive physiotherapy. LEVEL OF EVIDENCE: I.

[Poisoning of horses by the bark of the false acacia (Robinia pseudoacacia)]. / Vergiftung bei Pferden durch die Rinde der "Falschen Akazie" (Robinia pseudoacacia).

The present study describes the poisoning due to Robinia pseudoacacia in two horses. One of the horses showed mainly intestinal symptoms such as decreased intestinal motility and obstipation of the pelvic flexure. In the second animal central nervous symptoms were predominant. It showed intermittent phases of somnolence alternating with phases of excitation and head pressing. In addition mydriasis and a lacking menace response could be observed. Sensation to the head and the spinal reflexes were reduced. Symptomatic treatment was initiated in both animals and recovery occurred within 2 days.

[Peritonitis in horses: a retrospective study of 95 cases]. / Die Peritonitis beim Pferd: eine retrospektive Studie anhand von 95 Fällen.

Clinical signs of horses with peritonitis were colic (67.4%), elevated heart rate (53.2%), altered mucous membranes (75.8%), reduced intestinal motility (63.2%), increased tension of the abdominal wall (69.9%) and pyrexia (45.1%). The amount of obtained peritoneal fluid was increased in 62.3% of the horses. Colour and translucency of the peritoneal fluid were abnormal in 98.8% of the patients. The nucleated cell count was 83.5 (10-595) x 10(3)/microliter, protein content 35.6 g/l (+/-14.2), specific gravity 1027.3 (+/-7.4) and the relative amount of neutrophils was 87.8% (+/-11). The physical examination and the examination of the peritoneal fluid were of diagnostic value. Complete blood count and blood chemistry indicated the degree of circulatory depression and the duration of the disease. Overall mortality was 47.4% (45/95). Non-survivors had significantly more often an increased heart- and respiratory rate, altered mucous membranes, an increased tension of the abdominal wall, reduced intestinal motility and increased amount of peritoneal fluid. Packed cell volume, urea, creatinine, glutamatdehydrogenase, sorbitoldehydrogenase, lactatdehydrogenase and blood pH were significantly different between survivors and non-survivors. All these parameters were statistically of no prognostic value.