ARS a syndrome are the disease affecting sinews and ligaments which are attached to a simfiz and a pubic bone. In the beginning has inflammatory, then - degenerate and dystrophic character. It is caused by monotonous loadings and the repeating microinjuries. It is found in athletes. It is shown by the pains in the bottom of a stomach and inguinal area amplifying at assignment of a hip. It is diagnosed on the basis of complaints, the anamnesis, results of objective survey yielded a X-ray analysis, ultrasonography and MRT. Treatment includes restriction of loadings, medicines, physical therapy, surgical interventions.
ARS a syndrome – rather widespread disease among athletes. The abbreviation of ARS is deciphered as Adduktor-Rectus-Symphysis, contains Latin names of the struck structures: the bringing muscles of a hip, a direct muscle of a stomach, a lonny joint. The syndrome is known since 1958, the first description of pathology belongs to the Bulgarian doctor M. Bankov. Pathology enters into group of the miofastsialny pain syndromes which are localized in a basin zone. It is most often diagnosed for football players. Can occur at the persons which are actively doing any sports with intensive load of legs. Significantly limits possibilities of patients, can become the reason of the compelled withdrawal from big-time sports.
Discrepancy of volume of physical activities and ability of an organism to self-restoration, especially – against the background of instability of firm and myagkotkanny structures of area of a basin, the lower extremity is the main reason for development of a disease. The syndrome is provoked by monotonous asymmetrical loads of a hip, the lower part of a stomach and inguinal area (for example, at the forced reduction of the lower extremity at the time of blow to a ball). The situation is aggravated with the unreasoned mode of trainings and premature return to sports occupations after a trauma.
At an overload of sinews and sheaves there are microgaps in zones of the greatest tension of fabrics. In response to damage local sites of hypostasis and a zone of an inflammation are formed. Resistance of a sinew to loadings decreases, blood circulation conditions in the struck zone worsen. Listed leads to emergence of an increasing number of microgaps, formation of microhems and areas of fatty regeneration. Degenerate and dystrophic joins inflammatory process. The entezopatiya develops, tendinit and tendovaginit sinews of muscles of a stomach and a hip in combination with similar process in ligaments and sinews of a simfiz.
Pathology comes to light at the young people who are actively playing sports, usually – at professional athletes. Patients show complaints to the pain in inguinal area irradiating on the course of the affected muscles. Intensity of a pain syndrome can vary from insignificant or moderate to expressed, significantly limiting activity of the patient. Connection of pain with certain physical activities is noted. At a palpation local morbidity in a projection of sinews is defined. When conducting functional tests (reduction of a hip with a resistance, assignment of a hip, tension of muscles of a stomach) the pain syndrome amplifies.
At it is long the existing ARS syndrome because of the expressed degeneration of tendinous fabric the probability of large injuries (anguishes and gaps) increases. In some cases long preservation of symptomatology of a disease involves the compelled restriction of physical activity, nonparticipation in competitions and even refusal of sports career. Complications can be also caused by medicamentous therapy of pathology – at frequent blockade with use of glyukokortikosteroidny medicines possibly aggravation of degenerate processes in the struck department.
The preliminary diagnosis is quite often exposed by the sports doctor. Statement of the final diagnosis requires survey of the orthopedist and carrying out hardware researches. The characteristic anamnesis (intensive monotonous asymmetrical loadings), complaints to the pains in a groin amplifying at the movements, positive results of functional tests allows to suspect pathology. For confirmation of the diagnosis the following tool techniques are appointed:
- Radiological research. At the long course of a disease in pictures of a basin existence of degenerate and dystrophic changes in a zone of a joint of lonny bones is found. Similar defeats sacral joints are possible.
- Ultrasonography of a lonny joint. During a sonografiya the condition of cartilaginous and bone structures, top departments of muscles of a hip, areas of an attachment of their sinews (entez) is estimated. By results of the procedure expansion of a simfiz, the degeneration of tendinous and muscle fibers which is especially expressed in the zone adjacent to a bone is defined.
- MRT of bones of a basin. Scanning allows to visualize an inflammation and a degeneration in entezisa and adjacent parts of sinews, and also in the field of a simfiz and sacral joints.
Treatment of ARS syndrome
Treatment of this pathology can be performed on an outpatient basis or in the conditions of office of traumatology and orthopedics, to be conservative or quick. An important condition of successful therapy is the exception of intensive physical activities. The patient recommend to stop trainings temporarily. At early stages use medicamentous therapy, physical therapy. Appoint NPVS of the general action, enter kortikosteroidny means into the struck zone. Patients are directed to laser therapy, magnetotherapy, Bernard's currents, an electrophoresis with the anesthetizing medicines, by massage, LFK. Apply a kinezioterapiya on a zone of a lonny joint and adjacent muscles. The most effective conservative method of treatment is shock and wave therapy.
At inefficiency of conservative techniques, a frequent recurrence surgical intervention is shown. During operation at ARS syndrome make a partial section of the muscles of a hip and a stomach involved in pathological process with their one-stage plastic reconstruction. To the patient allow to rise for the second day after surgical intervention. In the postoperative period appoint analgetics, antibacterial means. In 3 weeks at the satisfactory data of ultrasonography confirming sufficient restoration of the operated structures begin rehabilitation which includes physiotherapy exercises, an elektromiostimulyation, a gidrokinezoterapiya. In a month allow run without obstacles and accelerations. In one and a half months of the patient allow to trainings, recommend gradual increase in loading.
Forecast and prevention
The forecast at ARS syndrome can be considered how conditionally favorable. Efficiency of conservative therapy is small, after use of physical therapy and medicamentous means steady improvement occurs at 20-25% of patients. The best results are noted after performing shock and wave therapy. After expeditious treatment the pain syndrome disappears, patients come back to sports activities in the usual mode, however in the remote period a recurrence is possible. Preventive measures include the thought-over mode of trainings, gradual increase in sports loadings, providing the sufficient period of recovering from injuries.
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