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Ooi MWX, Marzetti M, Rowbotham E, Bertham D, Robinson P. MRI findings in athletic groin pain: correlation of imaging with history and examination in symptomatic and asymptomatic athletes. Skeletal Radiol 2024:10.1007/s00256-024-04603-9. [PMID: 38302788 DOI: 10.1007/s00256-024-04603-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE To determine differences in prevalence and diagnostic accuracy of MRI findings between asymptomatic athletes and athletes with longstanding groin pain. MATERIALS AND METHODS One hundred twenty-three adult male athletes were approached with 85 consecutive athletes recruited. Group 1 (symptomatic, n = 34) athletes referred for longstanding groin pain (insidious onset, > 3 weeks duration). Group 2 (control, n = 51) athletes referred for injuries remote from the pelvis and no groin pain in the last 12 weeks. All referrers completed a clinical examination proforma documenting absence or presence of pelvis and hip abnormality. All patients completed the Copenhagen Hip and Groin Outcome Score (HAGOS) questionnaire and underwent a 3T MRI groin and hip protocol. MRIs were scored independently by two musculoskeletal radiologists blinded to clinical details. Statistical analysis was performed to evaluate associations between MRI findings, inter-reader reliability, clinical examination and HAGOS scores. RESULTS Pubic body subchondral bone oedema, capsule/aponeurosis junction tear and soft tissue oedema were more prevalent in the symptomatic group (p = 0.0003, 0.0273 and 0.0005, respectively) and in athletes with clinical abnormality at symphysis pubis, adductor insertion, rectus abdominis, psoas and inguinal canal (p = 0.0002, 0.0459 and 0.00002, respectively). Pubic body and subchondral oedema and capsule/aponeurosis tear and oedema significantly correlated with lower (worse) HAGOS scores (p = 0.004, 0.00009, 0.0004 and 0.002, respectively). Inter-reader reliability was excellent, 0.87 (range 0.58-1). Symphyseal bone spurring, disc protrusion and labral tears were highly prevalent in both groups. CONCLUSION Clinical assessment and MRI findings of pubic subchondral bone oedema and capsule/aponeurosis abnormality appear to be the strongest correlators with longstanding groin pain.
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Affiliation(s)
- Michelle Wei Xin Ooi
- Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK
| | - Matthew Marzetti
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Department of Medical Physics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Emma Rowbotham
- Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Dominic Bertham
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Philip Robinson
- Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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Probyn L, Flores D, Rowbotham E, Cresswell M, Atinga A. High-resolution ultrasound in the evaluation of the adult hip. J Ultrason 2023; 23:e223-e238. [PMID: 38020511 PMCID: PMC10668929 DOI: 10.15557/jou.2023.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/27/2023] [Indexed: 12/01/2023] Open
Abstract
This paper reviews ultrasound of the hip, which is a commonly requested examination for symptomatic hip issues. This includes both intra-articular and extra-articular causes of hip pain. Ultrasound is easily accessible, lacks radiation exposure, and allows for evaluation of the contralateral hip as well as assessment of dynamic maneuvers. Ultrasound can be used to guide interventional procedures. Ultrasound of the hip can be challenging due to the deep location of structures and complex anatomy. Typically, high-frequency transducers are used to examine the hip, however the choice of ultrasound transducer depends on the patient's body habitus, with lower frequency transducers required to penetrate deep structures in obese patients. It is important to have an approach to ultrasound of the hip which includes assessment of the anterior, lateral, posterior, and medial aspects of the hip. The technique and relevant anatomy of each of these compartments are discussed as well as the use of Doppler examination of the hip. Several dynamic maneuvers can be performed to help determine the cause of hip pathology in various locations, and these are described and illustrated. Ultrasound is useful for guided procedures about the hip, and these indications will be reviewed.
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Affiliation(s)
- Linda Probyn
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Dyan Flores
- Department of Medical Imaging, University of Ottawa, Ottawa, Canada
| | - Emma Rowbotham
- Department of Medical Imaging, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Mark Cresswell
- Department of Medical Imaging, University of British Columbia, Vancouver, Canada
| | - Angela Atinga
- Department of Medical Imaging, University of Toronto, Toronto, Canada
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Weber MA. [Groin pain in athletes-sportsmen's groin]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:268-274. [PMID: 36715718 DOI: 10.1007/s00117-023-01117-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 01/31/2023]
Abstract
CLINICAL/METHODICAL ISSUE Groin pain in athletes can have various causes. Radiologically, osteitis pubis and clefts with affection of the interpubic disc as well as muscle and tendon tears near the pubic bone can be clearly identified. STANDARD RADIOLOGICAL METHODS Magnetic resonance imaging (MRI) is the imaging modality of choice, as well as single-leg stand imaging (flamingo view radiographs), and where appropriate symphysography. METHODICAL INNOVATIONS Optimized MRI sequence protocol with oblique (axial oblique) slices parallel to the linea arcuata of the iliac bone is recommended. High-resolution MRI sequences and symphysography can detect superior and secondary cleft formation. Instabilities of the pubic symphysis can be diagnosed using flamingo view radiographs. PERFORMANCE The MRI findings of osteitis pubis and clinical symptoms correlate. The presence of parasymphyseal bone marrow edema is the earliest morphological sign of acute osteitis pubis on MR imaging. Edema in the periosteal tissue and isolated muscle lesions next to the symphysis are generally associated with more severe clinical symptoms. ACHIEVEMENTS AND PRACTICAL RECOMMENDATIONS Close communication between radiologists and the referring physicians is indispensable when planning an adequate imaging protocol, and precise knowledge of the clinical symptoms in the case of clinical suspicion of osteitis pubis allows for a reliable diagnosis and provides important prognostic information.
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Affiliation(s)
- Marc-André Weber
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland.
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Novel Use of Botulinum Toxin in Long-Standing Adductor-Related Groin Pain: A Case Series. Clin J Sport Med 2022; 32:567-573. [PMID: 36070357 DOI: 10.1097/jsm.0000000000001066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 07/28/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Adductor-related groin pain (ARGP) is the most common groin injury in athletes. If conservative treatment fails, then adductor tenotomy to relieve tension can be considered. The use of botulinum toxin A (BoNT-A) has shown good results in other musculoskeletal pathologies. OBJECTIVE Assess the effectiveness of BoNT-A injections in ARGP in cases where usual treatment has failed. DESIGN Retrospective cohort study. SETTING Orthopedic Medicine and Rehabilitation Unit, University of Bordeaux. PARTICIPANTS Fifty patients treated by BoNT-A injection in ARGP after failure of medical and/or surgical treatment were included in this study. INTERVENTIONS One or several adductor muscles were injected with BoNT-A, according to clinical evaluation using ultrasound and electrical stimulation guidance. Patients were followed up at 1, 3, 6, and 12 months. MAIN OUTCOME MEASURES The primary assessment criterion was the improvement of Hip and Groin Outcome Score subscales at day 30. Secondary outcomes included pain intensity and impact on sport, work, and quality of life (QoL), the Blazina scale, and side effects. RESULTS All the first 50 injected patients (45 male and 5 female patients) were included. A significant improvement was noted regarding the majority of Hip and Groin Outcome Score subscales at day 30 ( P < 0.05). Pain intensity and its impacts were both significantly reduced ( P < 0.001): less sport and professional disability and lower impact on QoL. Severity of symptoms assessed by the Blazina scale was significantly reduced ( P < 0.001). The improvements remained significant until 1-year postinjection. CONCLUSIONS BoNT-A is promising as a new treatment for ARGP but should be fully assessed in a randomized controlled trial.
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Nakayama K, Utsunomiya H, Murata Y, Takada S, Tsukamoto M, Sakai A, Uchida S. Cleft Sign and Bone Marrow Edema of the Pubic Symphysis Are Associated With Sports and Bony Morphology in Patients With Femoroacetabular Impingement and Labral Tears. Orthop J Sports Med 2022; 10:23259671211068477. [PMID: 35141338 PMCID: PMC8819768 DOI: 10.1177/23259671211068477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 09/16/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The cleft sign (CS) and bone marrow edema (BME) are considered magnetic
resonance imaging (MRI) findings signifying a pubic pathology, which is
associated with groin pain; however, their relationship with bony morphology
related to femoroacetabular impingement (FAI) has not been established. Purpose: To investigate the prevalence of CS and BME in symptomatic patients with
acetabular labral tears and assess their possible association with bone
morphology and sport-specific activities. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study enrolled 418 patients (469 hips) undergoing hip arthroscopic
surgery for labral tears. Also included were patients with labral tears in
the setting of either hip dysplasia or borderline hip dysplasia who were
undergoing endoscopic shelf acetabuloplasty combined with hip arthroscopic
labral repair, cam osteoplasty, and capsular plication. All patients were
screened for superior CS (SCS), inferior CS (ICS), and BME of the
ipsilateral side of the pubis using 3-T MRI. We measured the following
angles: lateral center edge (LCE), Sharp, Tönnis, vertical-central-anterior,
and alpha. Then, we evaluated the relationship between patient
characteristics and abnormal findings on MRI scans (preoperatively vs 1 year
postoperatively). Results: An overall 397 hips were included: 200 in men and 197 in women (mean ± SD
age, 35.3 ± 16.0 years). There were hips in 214 athletes (53.9%) and hips in
183 nonathletes (46.1%). MRI findings revealed SCS, ICS, and BME in 18
(4.5%), 13 (3.3%), and 34 hips (8.6%), respectively. Abnormal MRI findings
at the pubis were seen more often in athletes than nonathletes (23.8% vs
3.3%), and contact sports athletes had the most frequent abnormalities.
There was no SCS in patients with an LCE angle <22°. SCS was more
frequently seen in those who had an alpha angle ≥71°. More than 60% of
abnormal findings at the pubis diminished after arthroscopic surgery that
included FAI correction and labral repair. Conclusion: In patients with labral tears, CS and BME were seen more frequently in
athletes versus nonathletes, especially contact athletes with FAI-related
bony abnormalities. More than 60% of abnormal MRI pubis findings resolved
after arthroscopic treatment of FAI.
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Affiliation(s)
- Keisuke Nakayama
- Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hajime Utsunomiya
- Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoichi Murata
- Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shinichiro Takada
- Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Manabu Tsukamoto
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Akinori Sakai
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Soshi Uchida
- Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
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Dallaudiere B, Sylvain B, Poussange N, Reboul G, Silvestre A, Meyer P, Hocquelet A, Pesquer L. Ultrasound feature variants of the adductor longus tendon in asymptomatic sportive subjects: Management implications. Eur J Radiol 2021; 144:109928. [PMID: 34562742 DOI: 10.1016/j.ejrad.2021.109928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/28/2021] [Accepted: 08/13/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The potential contribution of ultrasound (US) to diagnose adductor longus (AL) tendinopathy in athletic pubalgia requires clarification. We investigate US findings from AL tendons of asymptomatic participants to identify the range and prevalence of common US features not associated with groin pain. METHODS We consecutively enrolled 45 volunteers physically active participants with no history of groin pain. US features of bilateral AL tendons were investigated and recorded by two experienced musculoskeletal radiologists (MSKR) in accordance with a defined ultrasound protocol. Two other MSKRs retrospectively and independently analyzed all US images. RESULTS Ninety AL tendons from 45 participants (4/45 women) were imaged (average age: 35 years ±14.6; dominant side: 37/45 (82.2%) right, 8/45 (17.8%) left). Abnormalities on US were found in all 45 (100%) AL tendons, including: abnormal echogenicity (98.9%/100% respectively according to reader), loss of fibrillar structure (92.2%/97.8%), irregularities of the superficial paratendon (23.3%/30%), calcifications (22.2%/25.5%), and cortical erosion (52%/55.5%), with excellent inter-observer assessment. No AL tears or hyperemia at color Doppler were detectable. CONCLUSIONS AL tendon abnormalities were identified via US in 100% of our asymptomatic athletes. The significance of these US findings should be interpreted cautiously with respect to clinical presentation. On the other hand, there is a need for supplemental investigation into the clinical relevance of US AL tendon tears not present in the present asymptomatic athlete population.
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Affiliation(s)
- Benjamin Dallaudiere
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France; Département d'imagerie musculo-squelettique, centre hospitalier universitaire Pellegrin, place Amélie-Léon-Rabat, 33000 Bordeaux, France.
| | - Bise Sylvain
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Nicolas Poussange
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Gilles Reboul
- Centre de chirurgie orthopédique et sportive, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Alain Silvestre
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Philippe Meyer
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Arnaud Hocquelet
- Service de radiologie et d'imagerie diagnostique et interventionnelle, CHU Vaudois, 1011 Lausanne, Suisse
| | - Lionel Pesquer
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France
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Baida SR, King E, Richter C, Gore S, Franklyn-Miller A, Moran K. Hip Muscle Strength Explains Only 11% of the Improvement in HAGOS With an Intersegmental Approach to Successful Rehabilitation of Athletic Groin Pain. Am J Sports Med 2021; 49:2994-3003. [PMID: 34398640 PMCID: PMC8411474 DOI: 10.1177/03635465211028981] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Exercise-based rehabilitation targeting intersegmental control has high success rates and fast recovery times in the management of athletic groin pain (AGP). The influence of this approach on hip strength and lower limb reactive strength and how these measures compare with uninjured athletes (CON) remain unknown. Additionally, the efficacy of this program after return to play (RTP) has not been examined. PURPOSE First, to examine differences in isometric hip strength, reactive strength, and the Hip and Groin Outcome Score (HAGOS) between the AGP and CON cohorts and after rehabilitation; second, to examine the relationship between the change in HAGOS and the change in strength variables after rehabilitation; last, to track HAGOS for 6 months after RTP. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A total of 42 athletes diagnosed with AGP and 36 matched controls completed baseline testing: isometric hip strength, lower limb reactive strength, and HAGOS. After rehabilitation, athletes with AGP were retested, and HAGOS was collected at 3 and 6 months after RTP. RESULTS In total, 36 athletes with AGP completed the program with an RTP time of 9.8 ± 3.0 weeks (mean ± SD). At baseline, these athletes had significantly lower isometric hip strength (abduction, adduction, flexion, extension, external rotation: d = -0.67 to -1.20), single-leg reactive strength (d = -0.73), and HAGOS (r = -0.74 to -0.89) as compared with the CON cohort. Hip strength (d = -0.83 to -1.15) and reactive strength (d = -0.30) improved with rehabilitation and were no longer significantly different between groups at RTP. HAGOS improvements were maintained or improved in athletes with AGP up to 6 months after RTP, although some subscales remained significantly lower than the CON group (r = -0.35 to -0.51). Two linear regression features (hip abduction and external rotation) explained 11% of the variance in the HAGOS Sports and Recreation subscale. CONCLUSION Athletes with AGP demonstrated isometric hip strength and reactive strength deficits that resolved after an intersegmental control rehabilitation program; however, improved hip strength explained only 11% of improvement in the Sports and Recreation subscale. HAGOS improvements after pain-free RTP were maintained at 6 months.
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Affiliation(s)
- Samuel R. Baida
- Sports Medicine Department, Sports
Surgery Clinic, Dublin, Ireland,School of Health and Human Performance,
Dublin City University, Dublin, Ireland,Insight Centre for Data Analytics,
Dublin City University, Dublin, Ireland,Samuel R. Baida, PT, PhD,
Sports Surgery Clinic, Santry, Dublin 9, Ireland (
) (Twitter: @Sam_Baida)
| | - Enda King
- Sports Medicine Department, Sports
Surgery Clinic, Dublin, Ireland,Department of Life Sciences, Roehampton
University, London, UK
| | - Chris Richter
- Sports Medicine Department, Sports
Surgery Clinic, Dublin, Ireland
| | - Shane Gore
- School of Health and Human Performance,
Dublin City University, Dublin, Ireland,Insight Centre for Data Analytics,
Dublin City University, Dublin, Ireland
| | - Andrew Franklyn-Miller
- Sports Medicine Department, Sports
Surgery Clinic, Dublin, Ireland,Centre for Health, Exercise and Sports
Medicine, University of Melbourne, Melbourne, Australia
| | - Kieran Moran
- School of Health and Human Performance,
Dublin City University, Dublin, Ireland,Insight Centre for Data Analytics,
Dublin City University, Dublin, Ireland
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Chaari F, Rebai H, Boyas S, Rahmani A, Fendri T, Harrabi MA, Sahli S. Postural balance impairment in Tunisian second division soccer players with groin pain: A case-control study. Phys Ther Sport 2021; 51:85-91. [PMID: 34303123 DOI: 10.1016/j.ptsp.2021.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare postural balance outcomes between soccer players with and without groin pain (GP). DESIGN Case-control study. SETTING Laboratory. PARTICIPANTS Fifty-four soccer players, 27 with GP (GP group: GPG) and 27 healthy ones (control group: CG). MAIN OUTCOME MEASURES Static and dynamic postural balance were assessed with a force platform and Y-balance test (Y-BT), respectively. Hip abduction, internal rotation (IR), external rotation (ER) and total rotation (TR) of both limbs were evaluated. RESULTS The GPG exhibited significant higher centre of pressure values in the bipedal posture only on the foam surface in eyes opened and closed compared to controls. Besides, they had lower anterior, posteromedial and posterolateral reach distances and composite Y-BT score on the injured limb (IL) compared to non-injured limb (NIL) and dominant-limb (DL) of the CG. Moreover, they showed lower abduction, IR, ER, and TR on the IL compared to NIL and DL. CONCLUSIONS Dynamic unipedal postural balance disorder could be one of the limiting factors of performance in soccer players with non-time loss GP. Hence, postural balance data in these players could enable sport coaches and physical therapists to better understand the mechanisms contributing for performance decrease.
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Affiliation(s)
- Fatma Chaari
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Tunisia.
| | - Haithem Rebai
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Tunisia.
| | - Sébastien Boyas
- Le Mans University, MIP, EA, 4334, Laboratory "Movement, Interactions, Performance", Faculty of Sciences and Technologies, Department of Sport Sciences, Le Mans, France.
| | - Abderrahmane Rahmani
- Le Mans University, MIP, EA, 4334, Laboratory "Movement, Interactions, Performance", Faculty of Sciences and Technologies, Department of Sport Sciences, Le Mans, France.
| | - Thouraya Fendri
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Tunisia.
| | - Mohammed A Harrabi
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Tunisia.
| | - Sonia Sahli
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Tunisia.
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Perrone MA, Noorzad A, Hamula M, Metzger M, Banffy M, Gerhardt M. Hip Adductor Longus Tendon Origin Anatomy Is Consistent and May Inform Surgical Reattachment. Arthrosc Sports Med Rehabil 2021; 3:e227-e232. [PMID: 33615269 PMCID: PMC7879210 DOI: 10.1016/j.asmr.2020.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/19/2020] [Indexed: 11/28/2022] Open
Abstract
Purpose To define the topographic anatomy of the footprint of the adductor longus origin on the pubis and its underlying bony morphology to better inform surgical repair of adductor longus tendon injuries. Methods Five cadaveric pelvis specimens were dissected, making 10 adductor footprints available for analysis. The adductor longus tendon origin was isolated and the surrounding tissue debrided. The circumference of the tendinous attachment to the pubic crest was marked before excising the tendon and fibrocartilage enthesis from the pubis. Radiopaque paint was prepared by mixing 30 mL of all-purpose acrylic paint (Anita’s no. 11150 Island Blue; Rust-Oleum Corp, Vernon Hills, IL) with 15g of E-Z-HD 98% w/w barium sulfate (Bracco Diagnostics Inc., Anjou Quebec, Canada) and applied to the marked footprint. The specimens underwent a 1.0-mm slice computed tomographic scan with 3-dimensional reconstructions. Synapse PACS (FujiFilm, Valhalla, NY) software for measurements of the tendon footprint and underlying bone. Results Average age and weight of the specimens at the time of death was 37 years and 204.6 ± 48.7 lbs, respectively. The width and length of the tendon origin was 12.0 ± 1.1 mm and 10.9 ± 1.1 mm, respectively. The distance of the center of the footprint from the center of the pubic tubercle was 8.5 ± 1.4 mm lateral and 12.2 ± 0.4 mm caudal. The osseous thickness underlying the footprint was 18.7 ± 3.7 mm at an angle of 34.5 ± 1.5° in relation to the sagittal plane. The correlation between specimen body weight and the thickness of the bone underlying the footprint was strongly positive (r = 0.92). Conclusions We found that there is a consistent angle from the center of the adductor longus tendon footprint to the point of maximal underlying bony thickness, as well as a positive correlation between body mass index and osseous thickness, which may inform anatomic reattachment of this tendon. Clinical Relevance Our findings will assist surgeons in identifying the footprint of the adductor longus tendon and safely perform anatomic repair of adductor longus tendon avulsions.
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Affiliation(s)
- Michael A Perrone
- Cedars Sinai Kerlan-Jobe Orthopaedic Institute, Los Angeles, California, U.S.A
| | - Ali Noorzad
- Cedars Sinai Department of Orthopaedics, Los Angeles, California, U.S.A
| | - Mathew Hamula
- Cedars Sinai Kerlan-Jobe Orthopaedic Institute, Los Angeles, California, U.S.A
| | - Melodie Metzger
- Metzger Biomechanics Laboratory at Cedars-Sinai Medical Center, Los Angeles, California, U.S.A
| | - Michael Banffy
- Cedars Sinai Kerlan-Jobe Orthopaedic Institute, Los Angeles, California, U.S.A
| | - Michael Gerhardt
- Cedars Sinai Kerlan-Jobe Orthopaedic Institute, Los Angeles, California, U.S.A.,Santa Monica Orthopaedic and Sports Medicine Group, Los Angeles, California, U.S.A
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10
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Proximal adductor avulsions are rarely isolated but usually involve injury to the PLAC and pectineus: descriptive MRI findings in 145 athletes. Knee Surg Sports Traumatol Arthrosc 2021; 29:2424-2436. [PMID: 32767053 PMCID: PMC8298372 DOI: 10.1007/s00167-020-06180-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/20/2020] [Indexed: 11/06/2022]
Abstract
PURPOSE The purpose of the study is to review the MRI findings in a cohort of athletes who sustained acute traumatic avulsions of the adductor longus fibrocartilaginous entheses, and to investigate related injuries namely the pyramidalis-anterior pubic ligament-adductor longus complex (PLAC). Associated muscle and soft tissue injuries were also assessed. METHODS The MRIs were reviewed for a partial or complete avulsion of the adductor longus fibrocartilage, as well as continuity or separation of the adductor longus from the pyramidalis. The presence of a concurrent partial pectineus tear was noted. Demographic data were analysed. Linear and logistic regression was used to examine associations between injuries. RESULTS The mean age was 32.5 (SD 10.9). The pyramidalis was absent in 3 of 145 patients. 85 of 145 athletes were professional and 52 competed in the football Premier League. 132 had complete avulsions and 13 partial. The adductor longus was in continuity with pyramidalis in 55 athletes, partially separated in seven and completely in 81 athletes. 48 athletes with a PLAC injury had a partial pectineus avulsion. Six types of PLAC injuries patterns were identified. Associated rectus abdominis injuries were rare and only occurred in five patients (3.5%). CONCLUSION The proximal adductor longus forms part of the PLAC and is rarely an isolated injury. The term PLAC injury is more appropriate term. MRI imaging should assess all the anatomical components of the PLAC post-injury, allowing recognition of the different patterns of injury. LEVEL OF EVIDENCE Level III.
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Massa J, Vanstraelen F, Bogaerts S, Peers K. Prevalence of asymptomatic radiological findings in the groin region: a systematic review. PHYSICIAN SPORTSMED 2020; 48:378-384. [PMID: 32213080 DOI: 10.1080/00913847.2020.1746209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: The aim of this study is to investigate in current literature the prevalence of asymptomatic adductor and pubic abnormalities on MRI and ultrasound. Methods: A systematic review of the literature was carried out using PubMed to identify all studies reporting asymptomatic pubic- and adductor-related findings on MRI and/or ultrasound. All types of studies were eligible for inclusion, except case reports. Studies with an asymptomatic cohort, or where at least a part of the study population was asymptomatic, were included. Results: Thirteen studies were included. Two articles describe only asymptomatic adductor abnormalities, six articles only asymptomatic pubic abnormalities. Five articles describe both adductor and pubic abnormalities. All studies were conducted with MRI. Only one of the included articles describes asymptomatic groin findings on ultrasound. Conclusions: Asymptomatic adductor and pubic abnormalities on MRI are frequently present but vary greatly between selected studies. No exact conclusions can be drawn about the prevalence of asymptomatic adductor or pubic findings on MRI due to high heterogeneity between studies. Furthermore, the one article about ultrasound was not enough to draw conclusions for ultrasound findings. It is nonetheless clear that clinicians should be careful to make diagnoses purely based on radiologic findings. A thorough clinical examination and individual interpretation conducted by the clinician remains indispensable.
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Affiliation(s)
- Jonas Massa
- Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven , Leuven, Belgium
| | | | - Stijn Bogaerts
- Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven , Leuven, Belgium.,Department of Development and Regeneration, KU Leuven , Leuven, Belgium.,Department of Physical Medicine and Rehabilitation, University Hospitals Leuven , Pellenberg, Belgium
| | - Koenraad Peers
- Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven , Leuven, Belgium.,Department of Development and Regeneration, KU Leuven , Leuven, Belgium.,Department of Physical Medicine and Rehabilitation, University Hospitals Leuven , Pellenberg, Belgium
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12
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Imaging of chronic male pelvic pain: what the abdominal imager should know. Abdom Radiol (NY) 2020; 45:1961-1972. [PMID: 31834458 DOI: 10.1007/s00261-019-02353-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Chronic pelvic pain is an important but underrecognized cause of morbidity in men. While there is abundant literature discussing female pelvic pain and the diagnostic role of imaging, much less attention has been given to imaging of non-gynecologic causes of chronic pelvic pain. Chronic pelvic pain in men can be a challenge to diagnose as pain may arise from visceral, musculoskeletal, or neurovascular pathology. Imaging of the pelvic viscera has been covered in detail elsewhere in this edition and therefore will not be reviewed here. We will focus upon topics less familiar to the abdominal radiologist, including imaging of pelvic floor, musculoskeletal, and neurovascular pathology.
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13
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Confino J, Irvine JN, O'Connor M, Ahmad CS, Lynch TS. Hip Injuries in Overhead Athletes. OPER TECHN SPORT MED 2019. [DOI: 10.1053/j.otsm.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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14
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Does athletic groin pain affect the muscular co-contraction during a change of direction. Gait Posture 2019; 73:173-179. [PMID: 31344606 DOI: 10.1016/j.gaitpost.2019.07.249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/04/2019] [Accepted: 07/17/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Groin pain is one of the common problems in multidirectional sports. It seems that abnormal muscular activity and improper movement strategy led to prolongation and high rate of this injury. Therefore, the aim of this study was to Comparing the Average amplitude of Electromyography (AEMG), co-contraction ratio (CCR) of selected thigh and thoracic muscle during turning in individuals with chronic groin pain and healthy individuals. METHODS Surface electromyography was collected from the internal oblique/transversus abdominis (IO/TrA), multifidus (MF), adductor Longus (AL) and gluteus Medius (GM) for AEMG and CCR analyzed in 16-males with LSGP and 16-controls in four motion phases during 11 cycles of gait coupled with turning. RESULTS Results revealed that in the AEMG apart from the third phase in the muscle of the IO/ Tr. A muscle and in the second phase in the MF muscle in the trunk and in the third phase in the muscle of the AL and the fourth phase in the GM foot Left There was a significant difference in other phases. There was a significant difference in the CCR, except in the second phase of the trunk and the fourth phase of the left foot in the rest of the phases. CONCLUSIONS It seems that in athletes with LSGP, have selective muscular activation and CCR have during turning, that may be resulting in compensatory strategies and movement control defects, which may be a useful tool to predict LSGP occurrence in players with a history of groin pain.
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15
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Abstract
CLINICAL/METHODICAL ISSUE Osteitis pubis is one of the most common causes of chronic groin pain in many professional athletes. Symphysitis pubis with instability of the joint due to softening of the joint capsule and muscular imbalance of the corresponding muscles increases the instability of the sympyseal region, thus, resulting in a vicious cycle. STANDARD RADIOLOGICAL METHODS Magnetic resonance imaging (MRI). METHODICAL INNOVATIONS Optimized MRI sequence protocol with oblique (axial oblique) layers parallel to the linea arcuata of iliac bone together with large image field for depiction of the entire pelvis and high-resolution sequences focused on the symphysis pubis. PERFORMANCE Recently, the correlation between MRI signs of osteitis pubis and long-term clinical outcome in a group of professional soccer players was examined. In particular, edema in the peri-osseous tissue and isolated muscle lesions around the symphysis at the onset of symptoms were associated with partial recovery of the athletes. Furthermore, a significant association of increased normalized signal intensity in the pubic bone on STIR (short-tau inversion recovery) sequences (corresponding presence and signal intensity of bone marrow edema) and a poor complete clinical improvement was observed. ACHIEVEMENTS An optimized MRI protocol allows the diagnosis of osteitis pubis and provides important prognostic information. PRACTICAL RECOMMENDATIONS In case of clinical suspicion on osteitis pubis, MR imaging with an optimized sequence protocol should be performed.
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16
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Riff AJ, Movassaghi K, Beck EC, Neal WH, Inoue N, Coleman SH, Nho SJ. Surface Mapping of the Musculotendinous Attachments at the Pubic Symphysis in Cadaveric Specimens: Implications for the Treatment of Core Muscle Injury. Arthroscopy 2019; 35:2358-2364. [PMID: 31395170 DOI: 10.1016/j.arthro.2019.02.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 02/18/2019] [Accepted: 02/19/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To characterize the 3-dimensional muscular, musculotendinous, and neurovascular anatomy about the pubic symphysis relevant to core muscle injury (CMI). METHODS Ten cadaveric hips were dissected to characterize the musculotendinous insertion of the rectus abdominis and inguinal ligament, origins of the adductor longus and adductor brevis, and the pubic cartilage plate. A 3-dimensional coordinate measuring system and data acquisition software were used to calculate structure cross-sectional area, and the landmark anatomical relationships to 1 another and relevant neurovascular structures. RESULTS All specimens were male with an average age of 62 ± 2 years. The mean footprints of the rectus abdominis, inguinal ligament, adductor longus, and adductor brevis were 8.4 ± 3.1, 1.2 ± 0.5, 3.8 ± 1.6, and 2.9 ± 1.3 cm2, respectively. The mean pectineus and gracilis footprints were 6.3 ± 2.4 and 3.4 ± 0.9 cm2, respectively. The mean cross-sectional area of the cartilage plate was 24.8 ± 5.6 cm2. The adductor longus was an average 1.5 ± 0.25 cm from the adductor brevis and 0.69 ± 0.52 cm from the rectus abdominis. The genital branch of the genitofemoral nerve was an average of 4.3 cm (range, 2.8-6.4) lateral to the insertion of the inguinal ligament. The femoral vein and artery were 3.0 cm (range, 2.5-3.6) and 3.7 cm (range, 2.5-5.9) lateral to the inguinal ligament footprint. The obturator nerve was 2.5 cm (range, 1.6-3.4) lateral to the adductor longus. CONCLUSIONS Familiarity with the anatomy of the pubic symphysis is essential for surgeons treating patients with CMI. We have shown that this relatively small area is the site of many muscular, musculotendinous, and neurovascular structures with various sized footprints and described the 3-dimensional anatomy of the anterior pubic symphysis. The origin of the adductor longus lies in close proximity to other structures, such as the adductor brevis, the insertion of the rectus abdominis, and the obturator nerve. These findings should be considered when operating in this region and treating patients with chronic groin pain. CLINICAL RELEVANCE The anatomy of the pelvic region and pubic symphysis has not been well characterized. Intimate knowledge of relevant anatomy is essential to treating CMI, also known as athletic pubalgia or sports hernia.
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Affiliation(s)
- Andrew J Riff
- Department of Orthopaedic Surgery, Indiana University Health, Indianapolis, Indiana, U.S.A
| | - Kamran Movassaghi
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Edward C Beck
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A..
| | - William H Neal
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nozomu Inoue
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Struan H Coleman
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Shane J Nho
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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17
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Todeschini K, Daruge P, Bordalo-Rodrigues M, Pedrinelli A, Busetto AM. >Imaging Assessment of the Pubis in Soccer Players. Rev Bras Ortop 2019; 54:118-127. [PMID: 31363256 PMCID: PMC6529323 DOI: 10.1016/j.rbo.2017.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 12/21/2017] [Indexed: 11/25/2022] Open
Abstract
Objective
To compare the accuracy of ultrasound (US) with that of magnetic resonance imaging (MRI) in the detection of aponeurosis lesions of the rectus abdominis/adductor longus muscles, to study the characteristics of the athletes and imaging findings associated with pubalgia, and to demonstrate the importance of each method in evaluating this condition.
Materials and methods
The present study was conducted from 2011 to 2016 with 39 professional soccer players: 15 with pubalgia and 24 without pubalgia. Age, field position, body mass index (BMI), weekly training load, career length, and history of thigh/knee injury and lower back pain were recorded. The following tests were performed: radiographs (anteroposterior view of the pelvis in standing and flamingo positions) to evaluate hip impingement, sacroiliac joint, and pubic symphysis instability; US to analyze the common aponeurosis of the rectus abdominis/adductor longus muscles and inguinal hernias; and MRI for pubic bone degenerative alterations and edema, and lesions in the adductor and rectus abdominis muscles and their aponeurosis.
Results
There was an association between pubalgia, high BMI (
p
= 0.032) and muscle alterations (
p
< 0.001). Two patients with pubalgia had inguinal hernias and one patient with pubalgia and two controls had sports hernias. Pubic degenerative changes were frequent in both groups. Aponeurosis lesions were more frequent in patients with pain. The US detection had 44.4% sensitivity and 100% specificity.
Conclusion
The evaluation of athletic pubalgia should be performed with radiography, US, and MRI. High BMI, muscle injuries, geodes, and osteophytes are findings associated with pubalgia; US has low sensitivity to detect injuries of the common aponeurosis of the rectus abdominis/adductor longus muscles.
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Affiliation(s)
- Karina Todeschini
- Hospital Santa Monica, Erechim, RS, Brasil
- Address for correspondence Karina Todeschini Hospital Santa MonicaErechim, RSBrasil
| | - Paulo Daruge
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Marcelo Bordalo-Rodrigues
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - André Pedrinelli
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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18
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Mizrahi DJ, Poor AE, Meyers WC, Roedl JB, Zoga AC. Imaging of the Pelvis and Lower Extremity: Demystifying Uncommon Sources of Pelvic Pain. Radiol Clin North Am 2018; 56:983-995. [PMID: 30322494 DOI: 10.1016/j.rcl.2018.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Pelvic pain can result from gastrointestinal, gynecologic, urologic, neurologic, and musculoskeletal sources. This article focuses on the musculoskeletal lesions that contribute to acute and chronic pain throughout the musculoskeletal core. Armed with an understanding of musculoskeletal core anatomy and biomechanics, imagers play an integral role in the accurate diagnosis and treatment planning for patients with pain and dysfunction from pelvic sources. MR imaging is the primary imaging modality used, but focused sonographic and radiographic techniques have a role. Ultimately, radiologists can help guide patients to the most appropriate subspecialty clinicians based on the underlying source of symptoms.
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Affiliation(s)
- Daniel J Mizrahi
- Division of Musculoskeletal Radiology, Thomas Jefferson University, 132 South 10th Street, Suite 1096, Philadelphia, PA 19118, USA
| | - Alex E Poor
- Vincera Institute, 1200 Constitution Avenue, Philadelphia, PA 19112, USA
| | - William C Meyers
- Vincera Institute, 1200 Constitution Avenue, Philadelphia, PA 19112, USA
| | - Johannes B Roedl
- Division of Musculoskeletal Radiology, Thomas Jefferson University, 132 South 10th Street, Suite 1096, Philadelphia, PA 19118, USA
| | - Adam C Zoga
- Division of Musculoskeletal Radiology, Thomas Jefferson University, 132 South 10th Street, Suite 1096, Philadelphia, PA 19118, USA.
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19
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Abstract
Traumatic and overuse hip injuries occur frequently in amateur and professional athletes. After clinical assessment, imaging plays an important role in diagnosis and in defining care management of these injuries. Ultrasonography (US) is being increasingly used in assessment of hip injuries because of the wide availability of US machines, the lower cost, and the unique real-time imaging capability, which allows both static and dynamic evaluation as well as guidance of point-of-care interventions such as fluid aspiration and steroid injection. Accurate diagnosis of hip injuries is often challenging, given the complex soft-tissue anatomy of the hip and the wide spectrum of injuries that can occur. To conduct a skillful US evaluation of hip injuries, physicians must have pertinent knowledge of the normal anatomy and should make judicious use of surface anatomy landmarks while using a compartmentalized diagnostic approach. In this article, common sports-related injuries of the anterior, lateral, and posterior hip compartments are discussed. This review includes assessment of joint effusion, acetabular labral tear, acute and chronic tendon injuries including tendinopathy, partial and full-thickness tears, snapping hip syndromes, relevant US-guided procedures, and some other conditions such as Morel-Lavallée lesion and perineal nodular induration. Principles of care management and current knowledge on imaging findings that may affect return to activity are also presented. Using an oriented US examination technique and having knowledge of the normal hip anatomy will help physicians characterize US findings of common sports-related hip injuries and make accurate diagnoses. Online supplemental material is available for this article. ©RSNA, 2018.
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Affiliation(s)
- Eugen Lungu
- From the Department of Radiology (E.L., N.J.B.), Department of Medicine (J.M.), and Research Center (N.J.B.), Centre Hospitalier de l'Université de Montréal, 1000 rue Saint-Denis, Montreal, QC, Canada H2X 0C1
| | - Johan Michaud
- From the Department of Radiology (E.L., N.J.B.), Department of Medicine (J.M.), and Research Center (N.J.B.), Centre Hospitalier de l'Université de Montréal, 1000 rue Saint-Denis, Montreal, QC, Canada H2X 0C1
| | - Nathalie J Bureau
- From the Department of Radiology (E.L., N.J.B.), Department of Medicine (J.M.), and Research Center (N.J.B.), Centre Hospitalier de l'Université de Montréal, 1000 rue Saint-Denis, Montreal, QC, Canada H2X 0C1
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20
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Watanabe K, Nunome H, Inoue K, Iga T, Akima H. Electromyographic analysis of hip adductor muscles in soccer instep and side-foot kicking. Sports Biomech 2018; 19:295-306. [PMID: 30102108 DOI: 10.1080/14763141.2018.1499800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A possible link between soccer-specific injuries, such as groin pain and the action of hip adductor muscles has been suggested. This study aimed to investigate neuromuscular activation of the adductor magnus (AM) and longus (AL) muscles during instep and side-foot soccer kicks. Eight university soccer players performed the two types of kick at 50%, 75% and 100% of the maximal ball speed. Surface electromyography (EMG) was recorded from the AM, AL, vastus lateralis (VL) and biceps femoris (BF) muscles of both kicking and supporting legs and the kicking motions were three-dimensionally captured. In the kicking leg, an increase in surface EMG with an increase in ball speed during instep kicking was noted in the AM muscle (p < 0.016), but not in AL, VL or BF muscles (p > 0.016). In the supporting leg, surface EMG of both AM and AL muscles was significantly increased with an increase in the ball speed before ball impact during both instep and side-foot kicks (p < 0.016). These results suggest that hip adductor muscles markedly contribute to either the kicking or supporting leg to emphasise the action of soccer kicks.
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Affiliation(s)
- Kohei Watanabe
- School of International Liberal Studies, Chukyo University, Nagoya, Japan
| | - Hiroyuki Nunome
- Faculty of Sports and Health Science, Fukuoka University, Fukuoka, Japan
| | - Koichiro Inoue
- Faculty of Education, Art and Science, Yamagata University, Yamagata, Japan
| | - Takahiro Iga
- Faculty of Sports and Health Science, Fukuoka University, Fukuoka, Japan
| | - Hiroshi Akima
- Research Centre of Health, Physical Fitness and Sports, Nagoya Univeristy, Nagoya, Japan
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21
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Bharam S, Feghhi DP, Porter DA, Bhagat PV. Proximal Adductor Avulsion Injuries: Outcomes of Surgical Reattachment in Athletes. Orthop J Sports Med 2018; 6:2325967118784898. [PMID: 30038918 PMCID: PMC6050820 DOI: 10.1177/2325967118784898] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Sports-related groin injuries are common among athletes. However, traumatic
proximal adductor avulsion injuries are relatively rare groin injuries in
the athletic population, with limited case reports describing suture anchor
repair. Purpose: To report on the outcomes of surgical reattachment of proximal adductor
avulsion injuries in athletes utilizing a suture anchor repair
technique. Study Design: Case series; Level of evidence, 4. Methods: Prospective data were collected on patients undergoing surgical reattachment
of proximal adductor avulsion injuries from December 2012 to May 2015 by a
single surgeon. Six athletes presented after a traumatic sports-related
injury with disabling groin pain, adductor weakness, and magnetic resonance
imaging confirmation of fibrocartilage avulsion of the proximal adductor
with retraction. Patient-reported outcomes (Hip Outcome Score–Activities of
Daily Living [HOS-ADL] and Hip Outcome Score–Sport Specific [SS] subscales,
modified Harris Hip Score [mHHS], and visual analog scale [VAS] for pain)
were collected preoperatively and at a minimum 2-year follow-up. Results: The latest follow-up of each patient averaged 33.4 months postoperatively
(range, 25-42.5 months). All patients returned to sporting activities, with
1 minor wound complication that resolved. Paired-samples t
tests indicated that the mean latest postoperative scores for all patients
were significantly better than their mean preoperative scores (HOS-ADL: 99.0
vs 43.2, HOS-SS: 98.9 vs 8.3, and mHHS: 97.1 vs 44.6, respectively;
P < .001 for all). Similarly, there was a
significant improvement in mean postoperative VAS scores for all patients
(from 89.2 to 2.2; P < .001). Conclusion: Patient-reported outcomes offer an objective measure of hip function and pain
control. Surgical reattachment utilizing a multiple suture anchor technique
is a successful procedure that allows for a safe return to athletic
performance and a predictable return to sport.
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Affiliation(s)
- Srino Bharam
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York, USA
| | - Daniel P Feghhi
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York, USA
| | - David A Porter
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York, USA
| | - Priyal V Bhagat
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York, USA
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22
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Dimitrakopoulou A, Schilders E. Focal osteopenia of pubic parasymphyseal bone as an underlying cause of groin pain in sports: a new perspective. BMJ Case Rep 2018; 2018:bcr-2017-223698. [PMID: 29728433 DOI: 10.1136/bcr-2017-223698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Groin pain is a common problem in athletes. The diagnosis can be difficult because of the complexity of the groin anatomy, the numerous clinical entities presenting with similar symptoms, the concurrence of those entities and the confusing terminology. Thus, a dilemma in diagnosis may arise leading to long-standing symptoms, disabling groin pain, mismanagement and therefore to poor treatment. Hereby, we present such a case of a recreational athlete complaining for excruciate pubic pain after being misdiagnosed and subsequently mistreated affecting her quality of life. We report on a new interesting finding, the focal osteopenia over the pubic parasymphyseal bone, together with administration of bisphosphonates for first time, as a treatment, for this condition in this body area. Our purpose is to shed light on the pathomechanism of groin pain labelled as osteitis pubis. We also outline the importance of thorough history and physical examination combined with appropriate advanced imaging.
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Affiliation(s)
- Alexandra Dimitrakopoulou
- London Hip Arthroscopy Centre at The Wellington Hospital and Fortius Clinic, London, UK.,Carnegie Faculty of Sports, Leeds Beckett University, Leeds, UK
| | - Ernest Schilders
- London Hip Arthroscopy Centre at The Wellington Hospital and Fortius Clinic, London, UK.,Carnegie Faculty of Sports, Leeds Beckett University, Leeds, UK
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23
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Ducouret E, Reboul G, Dalmay F, Iosif C, Mounayer C, Pesquer L, Dallaudiere B. MRI in chronic groin pain: sequence diagnostic reliability compared to systematic surgical assessment. Skeletal Radiol 2018; 47:649-660. [PMID: 29170813 DOI: 10.1007/s00256-017-2824-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the diagnostic reliability of magnetic resonance imaging (MRI) sequences in chronic groin pain (CGP) compared to surgery and try to propose a suitable MRI protocol. MATERIALS AND METHODS Forty-three consecutive patients with resistant clinical CGP underwent a pre-surgical pelvis MRI. Eight MRI sequences were acquired: axial fast spin-echo T1-weighted (FSE T1), coronal FSE T1, axial-oblique (in symphysis plane) proton density weighted with fat saturation (PDFS), coronal PDFS, sagittal PDFS, axial FSE T1 with fat saturation and gadolinium enhancement (FSGE), coronal FSE T1 FSGE and axial FSE T1 with Valsalva maneuver (VM). These sequences were reviewed for pubic symphysis assessment, adductor longus (AL) tendon and abdominal wall (AW) injuries. The same surgeon operated on all of these patients (26 AL and 49 AW). Sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative prospective value (NPV) and accuracy of each sequence and combinations for AL or AW injuries were calculated in comparison to surgical findings. RESULTS One hundred ninety-two sequences were obtained. Coronal T1 FSGE and axial T1 VM proved to be the most reliable sequences (accuracy: 91.67% in AL and 83.33% in AW). The best sequence combination was coronal T1, axial PDFS, sagittal PDFS and axial T1 VM (accuracy: 77.78%; Se: 100.00%, Sp: 69.23%, PPV: 55.56%, NPV: 100.00%). CONCLUSION MRI has 77.78% accuracy, 100.00% sensitivity, 69.23% specificity, 55.56% PPV and 100.00% NPV in evaluating CGP, with coronal T1-axial PDFS-sagittal PDFS-axial T1 VM as the optimal protocol in terms of diagnostic performance within a reasonable scan time. Diagnostic performance of MRI was examined in the evaluation of CGP using surgery as reference standard.
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Affiliation(s)
- Emmanuel Ducouret
- Département de Radiologie, Centre Hospitalier Universitaire Dupuytren, 2 Avenue Martin Luther King, 87042, Limoges, France.
| | - Gilles Reboul
- Service de Chirurgie Pariétale, Clinique du Sport de Bordeaux-Mérignac, 2 rue Georges Négrevergne, 33700, Mérignac, France
| | - François Dalmay
- CEBIMER, Centre Hospitalier Universitaire Dupuytren, 2 Avenue Martin Luther King, 87042, Limoges, France
| | - Christina Iosif
- CHU Jean Minjoz, Besançon, France.,BioEM, CNRS, UMR 7252, Université de Limoges, Limoges, France
| | - Charbel Mounayer
- Département de Neuroradiologie Interventionnelle, Centre Hospitalier Universitaire Dupuytren, 2 Avenue Martin Luther King, 87042, Limoges, France
| | - Lionel Pesquer
- Centre d'imagerie ostéoarticulaire, Clinique du Sport, Bordeaux Mérignac, 2, rue Georges-Négrevergne, 33700, Mérignac, France
| | - Benjamin Dallaudiere
- Centre d'imagerie ostéoarticulaire, Clinique du Sport, Bordeaux Mérignac, 2, rue Georges-Négrevergne, 33700, Mérignac, France.,Service de Radiologie, Département d'imagerie Musculo-Squelettique, Centre Hospitalier Universitaire Pellegrin, place Amélie-Léon-Rabat, 33000, Bordeaux, France.,Centre de Résonance Magnétique des Systèmes Biologiques, UMR 5536, CNRS, Université de Bordeaux, 146 rue Léo Saignat, 33076, Bordeaux, France
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24
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Benn ML, Pizzari T, Rath L, Tucker K, Semciw AI. Adductor magnus: An EMG investigation into proximal and distal portions and direction specific action. Clin Anat 2018. [PMID: 29520841 DOI: 10.1002/ca.23068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Cadaveric studies indicate that adductor magnus is structurally partitioned into at least two regions. The aim of this study was to investigate the direction-specific actions of proximal and distal portions of adductor magnus, and in doing so determine if these segments have distinct functional roles. Fine-wire EMG electrodes were inserted into two portions of adductor magnus of 12 healthy young adults. Muscle activity was recorded during maximum voluntary isometric contractions (MVICs) across eight tests (hip flexion/extension, internal/external rotation, abduction, and adduction at 0°, 45°, and 90° hip flexion). Median activity within each action (normalized to peak) was compared between segments using repeated measures nonparametric tests (α = 0.05). An effect size (ES = z-score/√sample size) was calculated to determine the magnitude of difference between muscle segments. The relative contribution of each muscle segment differed significantly during internal rotation (P < 0.001; ES = 0.88) and external rotation (P = 0.003, ES = 0.79). The distal portion was most active during extension [median (interquartile range); 100(0)% MVIC)] and internal rotation [58(34)% MVIC]. The proximal portion was most active during extension [100(49)% MVIC] and adduction [59(64)%MVIC], with low level activity during external rotation [15(41)%MVIC]. This study suggests that adductor magnus has at least two functionally unique regions. Differences were most evident during rotation. The different direction-specific actions may imply that each segment performs separate roles in hip stability and movement. These findings may have implications on injury prevention and rehabilitation for adductor-related groin injuries, hamstring strain injury, and hip pathology. Clin. Anat. 31:535-543, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Matthew L Benn
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Tania Pizzari
- La Trobe University Sports and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
| | - Leanne Rath
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Kylie Tucker
- School of Biomedical Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Adam I Semciw
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.,La Trobe University Sports and Exercise Medicine Research Centre, Bundoora, Victoria, Australia.,Department of Physiotherapy, Princess Alexandra Hospital, Wooloongabba, Brisbane, Queensland, Australia
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Osteitis pubis in professional football players: MRI findings and correlation with clinical outcome. Eur J Radiol 2017; 94:46-52. [PMID: 28941759 DOI: 10.1016/j.ejrad.2017.07.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/13/2017] [Accepted: 07/17/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Osteitis pubis (OP), a common pathology in elite athletes, is an aseptic inflammatory process of the pubic symphysis bone, and may involve surrounding soft tissues, tendons and muscles. OP is typically characterized by (often recurring) groin pain and is an important cause of time-off from sports activity in athletes. Aim of this retrospective study was to analyze magnetic resonance imaging (MRI) findings in professional football players with clinical diagnosis of OP and to correlate MRI findings with clinical outcome. MATERIAL AND METHODS All professional football players (23 males, 1 female; mean age: 21±3.7years; range: 16-30 years) with groin pain and clinical diagnosis of OP, who underwent pelvic MRI in our institution were retrospectively analyzed. The MR images were analyzed regarding the presence of bone marrow edema and its extension, whether fluid in the symphysis pubis or periarticular soft tissue edema with a rim-like periosteal distribution or edema in the muscles located around the symphyseal joint were present, whether degenerative changes of the symphysis pubis and of signs of symphyseal instability were encountered. A quantitative measurement of the signal intensity in bone marrow edema on 3T STIR sequences was performed, normalizing these values to the mean signal intensity values in the ipsilateral iliopsoas muscle. All patients were classified according to a 3-point grading scale. For each patient, both the symptoms 18 months after the initial MRI examination, the duration of time off from playing football and the kind of treatment applied were evaluated. RESULTS Among all professional athletes, in 20/24 (83.3%) MRI showed signs of OP with bone marrow edema at the pubic bone. 12 of these patients showed complete clinical recovery without any symptoms after 18 months, while in 8 patients partial recovery with persistence of groin pain during higher sports activity was observed. Patients with edema in periarticular soft tissues or in the muscles around the symphyseal joint on MRI at the beginning of symptoms presented significantly more often with a partial recovery after returning to high sports activity (p=0.042 and p=0.036, respectively). A partial recovery was also significantly associated with higher normalized mean signal intensity values in bone marrow edema on STIR sequences at the beginning of symptoms (mean=4.77±1.63 in the group with partial recovery vs. mean=2.86±0.45 in the group with complete recovery; p=0.0019). No significant association was noticed between MRI findings and time of abstinence from high sports activity, as well as between the 3-point grading scale and the time off from high sport activity and recovery at 18 months. CONCLUSIONS Edema in periarticular soft tissues, edema with extension to the muscles located around the symphyseal joint, as well as higher normalized signal intensity values in bone marrow edema on STIR sequences in the pubic bones at the beginning of groin pain are the most reliable MRI findings of a poor clinical long-term outcome of OP in professional football players and should be regarded as negative prognostic factors.
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Toslak IE, Cekic B, Turk A, Eraslan A, Parlak AE. Evaluation of Diffusion-weighted MR Imaging as a Technique for Detecting Bone Marrow Edema in Patients with Osteitis Pubis. Magn Reson Med Sci 2017; 16:317-324. [PMID: 28190854 PMCID: PMC5743523 DOI: 10.2463/mrms.mp.2016-0104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: Our aims were to determine the feasibility of diffusion-weighted magnetic resonance imaging (DWI) in the detection of bone marrow edema (BME) and explore the apparent diffusion coefficient (ADC) alterations in patients with osteitis pubis (OP). Materials and Methods: 42 consecutive patients clinically suspected to have athletic pubalgia and 31 control subjects were enrolled in the study. All subjects underwent diagnostic focused magnetic resonance imaging (MRI) and DWI at b values of 0 and 600 s/mm2. Two radiologists reviewed the images for the presence of active OP. The presence of subchondral BME and contrast enhancement were considered to indicate active OP. ADC values were measured from public bodies of both groups. DWI results were correlated with routine MRI findings. Receiver-operating-characteristic curves were formed. Cut-off values for ADC, sensitivity and specificity values were measured. Results: 36/42 (85%) of the cases had BME/enhancement on routine MRIs and identified as active OP. ADC measurements of the patients were greater than the controls (P < 0.05). For the optimal cut-off values DWI showed sensitivity and specificity values of 97.3%, and 90.3%, for the right, and 97.1%, and 96.7% for the left side, respectively (Area under the curve 0.965 and 0.973). Intra-and inter-rater reliability for readers were substantial-perfect for all sessions. Conclusion: DWI is fast, accurate, and highly reproducible technique for the detection of BME in patients with active OP. It allows distinct bone marrow contrast without the use of gadolinium contrast, increases visual perception of active lesions, gives objective information by quantifying the diffusion coefficients, thus increase diagnostic confidence. We suggest the use of DWI as a cost-effective adjunctive tool for the diagnosis of active OP particularly in early cases and inconclusive diagnostic MRI. Future studies are necessary to determine the utility of DWI to evaluate severity of the disease and treatment response before returning athletes to play.
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Affiliation(s)
| | - Bulent Cekic
- Department of Radiology, Antalya Training and Research Hospital
| | - Aysen Turk
- Department of Sports Medicine, Antalya Training and Research Hospital
| | - Ali Eraslan
- Department of Sports Medicine, Antalya Training and Research Hospital
| | - A Eda Parlak
- Department of Radiology, Antalya Training and Research Hospital
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Bisciotti GN, Volpi P, Zini R, Auci A, Aprato A, Belli A, Bellistri G, Benelli P, Bona S, Bonaiuti D, Carimati G, Canata GL, Cassaghi G, Cerulli S, Delle Rose G, Di Benedetto P, Di Marzo F, Di Pietto F, Felicioni L, Ferrario L, Foglia A, Galli M, Gervasi E, Gia L, Giammattei C, Guglielmi A, Marioni A, Moretti B, Niccolai R, Orgiani N, Pantalone A, Parra F, Quaglia A, Respizzi F, Ricciotti L, Pereira Ruiz MT, Russo A, Sebastiani E, Tancredi G, Tosi F, Vuckovic Z. Groin Pain Syndrome Italian Consensus Conference on terminology, clinical evaluation and imaging assessment in groin pain in athlete. BMJ Open Sport Exerc Med 2016; 2:e000142. [PMID: 28890800 PMCID: PMC5566259 DOI: 10.1136/bmjsem-2016-000142] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 12/14/2022] Open
Abstract
The nomenclature and the lack of consensus of clinical evaluation and imaging assessment in groin pain generate significant confusion in this field. The Groin Pain Syndrome Italian Consensus Conference has been organised in order to prepare a consensus document regarding taxonomy, clinical evaluation and imaging assessment for groin pain. A 1-day Consensus Conference was organised on 5 February 2016, in Milan (Italy). 41 Italian experts with different backgrounds participated in the discussion. A consensus document previously drafted was discussed, eventually modified, and finally approved by all members of the Consensus Conference. Unanimous consensus was reached concerning: (1) taxonomy (2) clinical evaluation and (3) imaging assessment. The synthesis of these 3 points is included in this paper. The Groin Pain Syndrome Italian Consensus Conference reached a consensus on three main points concerning the groin pain syndrome assessment, in an attempt to clarify this challenging medical problem.
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Affiliation(s)
- G N Bisciotti
- Qatar Orthopedic and Sport Medicine Hospital, Doha, Qatar
| | - P Volpi
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy.,FC Internazionale, Milan, Italy
| | - R Zini
- Azienda Ospedaliera "Ospedale San Salvatore", Pesaro, Italy
| | - A Auci
- Kinemove Rehabilitation Center, Pontremoli, La Spezia, Italy
| | | | - A Belli
- FC Internazionale, Milan, Italy
| | | | | | - S Bona
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | - D Bonaiuti
- Fisioclinic Centro Medico Polispecialistico, Pesaro, Italy
| | - G Carimati
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | | | - G Cassaghi
- Kinemove Rehabilitation Center, Pontremoli, La Spezia, Italy
| | - S Cerulli
- Institute of Sports Medicine of Turin, Italy
| | - G Delle Rose
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | | | - F Di Marzo
- Azienda Ospedaliera Universitaria di Udine, Italy
| | | | - L Felicioni
- Ospedale della Misericordia, Grosseto, Italy
| | | | - A Foglia
- Studio di fisioterapia Riabilita, Pesaro, Italy
| | - M Galli
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | | | - L Gia
- Azienda Ospedaliera Universitaria di Udine, Italy
| | | | - A Guglielmi
- Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - A Marioni
- Azienda Policlinico Università di Bari, Bari, Italy
| | | | | | - N Orgiani
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | | | - F Parra
- Kinemove Rehabilitation Center, Pontremoli, La Spezia, Italy
| | - A Quaglia
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | - F Respizzi
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | - L Ricciotti
- Kinemove Rehabilitation Center, Pontremoli, La Spezia, Italy
| | | | | | | | | | - F Tosi
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | - Z Vuckovic
- Qatar Orthopedic and Sport Medicine Hospital, Doha, Qatar
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28
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Oliveira ALD, Andreoli CV, Ejnisman B, Queiroz RD, Pires OGN, Falótico GG. Perfil epidemiológico dos pacientes com diagnóstico de pubalgia do atleta. Rev Bras Ortop 2016. [DOI: 10.1016/j.rbo.2016.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Oliveira ALD, Andreoli CV, Ejnisman B, Queiroz RD, Pires OGN, Falótico GG. Epidemiological profile of patients diagnosed with athletic pubalgia. Rev Bras Ortop 2016; 51:692-696. [PMID: 28050542 PMCID: PMC5198137 DOI: 10.1016/j.rboe.2016.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/07/2016] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To evaluate the clinical and epidemiological characteristics of pubalgia in patients from a Sports Medicine Center. METHODS Data analysis from medical records of patients with athletic pubalgia attended to from January 2007 to January 2015. The diagnosis was made by an experienced hip surgeon, complemented with pelvic X-ray, abdominal wall ultrasound, and magnetic resonance imaging of the pelvis. RESULTS Among 43 patients, 42 were men, with mean age of 33 years. As for sports, 25 (58.1%) athletes were soccer players and 13 (30.2%) were runners; 37.2% were professional athletes. Inguinal hernia was diagnosed in 20.9% of patients, showing the importance of its routine search in these patients. Treatment duration ranged from 1 to 12 months and 95.2% of the patients returned to sport. CONCLUSION This study presented the epidemiological characteristics of patients diagnosed with athletic pubalgia attended to in a reference medical center and demonstrated the prevalence of this lesion in male patients, soccer players and runners. It also disclosed a high success rate of the nonoperative treatment, and high rate of return to sport after treatment.
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Affiliation(s)
- Anderson Luiz de Oliveira
- Universidade Federal de São Paulo, Departamento de Ortopedia e Traumatologia, Centro de Traumatologia do Esporte, São Paulo, SP, Brazil
| | - Carlos Vicente Andreoli
- Universidade Federal de São Paulo, Departamento de Ortopedia e Traumatologia, Centro de Traumatologia do Esporte, São Paulo, SP, Brazil
| | - Benno Ejnisman
- Universidade Federal de São Paulo, Departamento de Ortopedia e Traumatologia, Centro de Traumatologia do Esporte, São Paulo, SP, Brazil
| | - Roberto Dantas Queiroz
- Universidade Federal de São Paulo, Departamento de Ortopedia e Traumatologia, Centro de Traumatologia do Esporte, São Paulo, SP, Brazil
| | - Osvaldo Guilherme Nunes Pires
- Universidade Federal de São Paulo, Departamento de Ortopedia e Traumatologia, Centro de Traumatologia do Esporte, São Paulo, SP, Brazil
| | - Guilherme Guadagnini Falótico
- Universidade Federal de São Paulo, Departamento de Ortopedia e Traumatologia, Centro de Traumatologia do Esporte, São Paulo, SP, Brazil
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Abstract
This article outlines adductor-related groin pain, pubic-related groin pain, inguinal-related groin pain, and iliopsoas-related groin pain, with a description of the corresponding functional anatomy and imaging findings. The imaging has been described mainly in terms of MR imaging findings as this is the principal imaging modality used to investigate groin pain, although plain radiographs and ultrasound can be very useful adjuncts in specific circumstances, especially if an alternative pathology needs to be excluded.
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Affiliation(s)
- Annu Chopra
- X-Ray department, Musculoskeletal Centre, Leeds Teaching Hospitals, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK
| | - Philip Robinson
- X-Ray department, Musculoskeletal Centre, Leeds Teaching Hospitals, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK; Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals, Chapel Allerton Hospital, Chapletown Road, Leeds LS7 4SA, UK.
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31
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Abstract
Groin pain encompasses a number of conditions from the lower abdomen, inguinal region, proximal adductors, hip joint, upper anterior thigh and perineum. The complexity of the anatomy, the heterogeneous terminology and the overlapping symptoms of different conditions that may co-exist epitomise the challenges in diagnosis and treatment. Inguinal-related and adductor-related pain is the most common cause of groin pain and will be discussed in this article.
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Sailly M, Whiteley R, Read JW, Giuffre B, Johnson A, Hölmich P. Pubic apophysitis: a previously undescribed clinical entity of groin pain in athletes. Br J Sports Med 2016; 49:828-34. [PMID: 26031648 PMCID: PMC4484496 DOI: 10.1136/bjsports-2014-094436] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Sport-related pubalgia is often a diagnostic challenge in elite athletes. While scientific attention has focused on adults, there is little data on adolescents. Cadaveric and imaging studies identify a secondary ossification centre located along the anteromedial corner of pubis beneath the insertions of symphysial joint capsule and adductor longus tendon. Little is known about this apophysis and its response to chronic stress. Aim We report pubic apophysitis as a clinically relevant entity in adolescent athletes. Methods The clinical and imaging findings in 26 highly trained adolescent football players (15.6 years±1.3) who complained of adductor-related groin pain were reviewed. The imaging features (X-ray 26/26, US 9/26, MRI 11/26, CT 7/26) of the pubic apophyses in this symptomatic group were compared against those of a comparison group of 31 male patients (age range 9–30 years) with no known history of groin pain or pelvic trauma, who underwent pelvic CT scans for unrelated medical reasons. Results All symptomatic subjects presented with similar history and physical findings. The CT scans of these patients demonstrated open pubic apophyses with stress-related physeal changes (widening, asymmetry and small rounded cyst-like expansions) that were not observed in the comparison group. No comparison subject demonstrated apophyseal maturity before 21 years of age, and immaturity was seen up to the age of 26 years. Conclusions This retrospective case series identifies pubic apophyseal stress (or ‘apophysitis’) as an important differential consideration in the adolescent athlete who presents with groin pain.
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Affiliation(s)
| | - Rod Whiteley
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar University of Sydney, Sydney, New South Wales, Australia
| | | | - Bruno Giuffre
- University of Sydney, Sydney, New South Wales, Australia Radiology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Amanda Johnson
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar University of Manchester, Manchester, UK
| | - Per Hölmich
- Aspetar Sports Groin Pain Center, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Arthroscopic Center Amager, Sports Orthopedic Research Center, Copenhagen, Denmark Copenhagen University Hospital, Amager-Hvidovre, Denmark
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Falvey ÉC, King E, Kinsella S, Franklyn-Miller A. Athletic groin pain (part 1): a prospective anatomical diagnosis of 382 patients--clinical findings, MRI findings and patient-reported outcome measures at baseline. Br J Sports Med 2015; 50:423-30. [PMID: 26626272 PMCID: PMC4819645 DOI: 10.1136/bjsports-2015-094912] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2015] [Indexed: 11/16/2022]
Abstract
Background Athletic groin pain remains a common field-based team sports time-loss injury. There are few reports of non-surgically managed cohorts with athletic groin pain. Aim To describe clinical presentation/examination, MRI findings and patient-reported outcome (PRO) scores for an athletic groin pain cohort. Methods All patients had a history including demographics, injury duration, sport played and standardised clinical examination. All patients underwent MRI and PRO score to assess recovery. A clinical diagnosis of the injured anatomical structure was made based on these findings. Statistical assessment of the reliability of accepted standard investigations undertaken in making an anatomical diagnosis was performed. Result 382 consecutive athletic groin pain patients, all male, enrolled. Median time in pain at presentation was (IQR) 36 (16–75) weeks. Most (91%) played field-based ball-sports. Injury to the pubic aponeurosis (PA) 240 (62.8%) was the most common diagnosis. This was followed by injuries to the hip in 81 (21.2%) and adductors in 56 (14.7%) cases. The adductor squeeze test (90° hip flexion) was sensitive (85.4%) but not specific for the pubic aponeurosis and adductor pathology (negative likelihood ratio 1.95). Analysed in series, positive MRI findings and tenderness of the pubic aponeurosis had a 92.8% post-test probability. Conclusions In this largest cohort of patients with athletic groin pain combining clinical and MRI diagnostics there was a 63% prevalence of PA injury. The adductor squeeze test was sensitive for athletic groin pain, but not specific individual pathologies. MRI improved diagnostic post-test probability. No hernia or incipient hernia was diagnosed. Clinical trial registration number NCT02437942.
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Affiliation(s)
- É C Falvey
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland Department of Medicine, University College Cork, Cork, Ireland
| | - E King
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland Department of Life Sciences, Roehampton University Dublin, London, UK
| | - S Kinsella
- Department of Medicine, University College Cork, Cork, Ireland
| | - A Franklyn-Miller
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia
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Coker DJ, Zoga AC. The Role of Magnetic Resonance Imaging in Athletic Pubalgia and Core Muscle Injury. Top Magn Reson Imaging 2015; 24:183-91. [PMID: 26244616 DOI: 10.1097/rmr.0000000000000056] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Magnetic resonance imaging (MRI) has become the standard of care imaging modality for a difficult, often misunderstood spectrum of musculoskeletal injury termed athletic pubalgia or core muscle injury. Armed with a dedicated noncontrast athletic pubalgia protocol and a late model phased array receiver coil, the musculoskeletal imager can play a great role in effective diagnosis and treatment planning for lesions, including osteitis pubis, midline pubic plate lesions, and rectus abdominis/adductor aponeurosis injury. Beyond these established patterns of MRI findings, there are many confounders and contributing pathologies about the pelvis in patients with activity related groin pain, including internal and periarticular derangements of the hip. The MRI is ideally suited to delineate the extent of expected injury and to identify the unexpected visceral and musculoskeletal lesions.
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Affiliation(s)
- Dana J Coker
- From the Department of Radiology, Division of Musculoskeletal, Thomas Jefferson University, Philadelphia, PA
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McAleer SS, Gille J, Bark S, Riepenhof H. Management of chronic recurrent osteitis pubis/pubic bone stress in a Premier League footballer: Evaluating the evidence base and application of a nine-point management strategy. Phys Ther Sport 2015; 16:285-99. [PMID: 26150099 DOI: 10.1016/j.ptsp.2015.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 03/26/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND/AIM The aim of this paper was to use a clinical example to describe a treatment strategy for the management of recurrent chronic groin pain and evaluate the evidence of the interventions. METHODS A professional footballer presented with chronic recurrent OP/PBS. The injury was managed successfully with a nine-point programme - 1. Acute pharmacological management. 2. Tone reduction of over-active structures. 3. Improved ROM at hips, pelvis and thorax. 4. Adductor strength. 5. Functional movement assessment. 6. Core stability. 7. Lumbo-pelvic control. 8. Gym-based strengthening. 9. Field-based conditioning/rehabilitation. The evidence for these interventions is reviewed. RESULTS The player returned to full training and match play within 41 and 50 days, respectively, and experienced no recurrence of his symptoms in follow up at 13 months. CONCLUSION This case report displays a nine-point conservative management strategy for OP/PBS, with non-time dependent clinical objective markers as the progression criteria in a Premier League football player.
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Affiliation(s)
- Stephen S McAleer
- Department of Sports Medicine and Science, Brighton and Hove Albion Football Club, Brighton, UK; British Athletics, University of Bath Sports Training Village, Bath, BA2 7AY, UK.
| | - Justus Gille
- Sektion Unfallchirurgie, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Stefan Bark
- Sektion Unfallchirurgie, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Helge Riepenhof
- Department of Sports Medicine and Science, Brighton and Hove Albion Football Club, Brighton, UK; Sektion Unfallchirurgie, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
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Abstract
STUDY DESIGN Resident's case problem. BACKGROUND Groin pain represents a diagnostic challenge and requires a diagnostic process that rules out life-threatening illness or disease processes. Osteomyelitis is a potential fatal disease process that requires accurate diagnosis and medical management. Osteomyelitis presents a problem for the outpatient physical therapist, as the described physical findings for the diagnosis of osteomyelitis are nonspecific. DIAGNOSIS A 67-year-old man with groin and bilateral medial thigh pain was referred for physical therapy care to address right adductor weakness and generalized deconditioning. He had undergone extensive treatment for bladder cancer, with a recent radical cystoprostatectomy and cutaneous urinary diversion with an Indiana pouch. Postsurgical magnetic resonance imaging indicated normal findings, and the patient was currently being managed by an orthopaedic surgeon, who diagnosed the patient as having obturator nerve palsy. The physical therapist's examination produced findings inconsistent with this diagnosis. Subsequently, nuclear medicine studies revealed pubic symphysitis/osteomyelitis with secondary myositis, predominantly affecting the right adductor muscles. DISCUSSION Osteomyelitis represents a difficult problem for the outpatient physical therapist. Careful consideration of red-flag symptoms and inconclusive physical testing indicate the need for further medical work-up. In this case, appropriate medical management led to improvement in patient function, highlighting the need for early diagnosis. LEVEL OF EVIDENCE Differential diagnosis, level 4.
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Branci S, Thorborg K, Bech BH, Boesen M, Nielsen MB, Hölmich P. MRI findings in soccer players with long-standing adductor-related groin pain and asymptomatic controls. Br J Sports Med 2014; 49:681-91. [DOI: 10.1136/bjsports-2014-093710] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2014] [Indexed: 11/04/2022]
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38
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Branci S, Thorborg K, Bech BH, Boesen M, Magnussen E, Court-Payen M, Nielsen MB, Hölmich P. The Copenhagen Standardised MRI protocol to assess the pubic symphysis and adductor regions of athletes: outline and intratester and intertester reliability. Br J Sports Med 2014; 49:692-9. [DOI: 10.1136/bjsports-2014-094239] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2014] [Indexed: 11/04/2022]
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Sheen AJ, Iqbal Z. Contemporary management of 'Inguinal disruption' in the sportsman's groin. BMC Sports Sci Med Rehabil 2014; 6:39. [PMID: 25937929 PMCID: PMC4417524 DOI: 10.1186/2052-1847-6-39] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 11/10/2014] [Indexed: 11/27/2022]
Abstract
Background This article helps define the basic principles to diagnosis and manage one of the surgically correctable causes of the ‘painful groin’, which is commonly described as the sportsman’s groin. Discussion Often many surgeons will describe a single pathology for the sportsman’s groin such as a ‘hernia’ but often other coexisting etiologies may be present. Management relies on a multidisciplinary approach with a diagnosis initially made by a history of pain in the groin on exercise. Physiotherapy is the recommended first line treatment and is designed to concentrate on strengthening of the abdominal wall muscle and tendon groups around the groin area. Surgery does have a role in the sportsman’s groin but only once all conservative measures have been exhausted or if there is a clear identified pathology causing the groin symptoms such as posterior wall defect. Surgical principles for an inguinal disruption include either open or laparoscopic techniques reinforcing the inguinal canal with a mesh or suture repair followed by an active rehabilitation programme. Summary Once an accurate diagnosis has been achieved, contemporary guidance for inguinal disruption requires a multidisciplinary approach including a specially designed physiotherapy regime and possibly surgery.
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Affiliation(s)
- Aali J Sheen
- Department of Hernia Surgery, Central Manchester Foundation Trust, Manchester Royal Infirmary, Manchester, M13 9WL UK
| | - Zafar Iqbal
- Sport's Medicine, Liverpool FC Training Ground, Melwood Drive, West Derby, Liverpool, L12 8SY U.K
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Abstract
CONTEXT Sports-related injuries of the hip are a common complaint of both competitive and recreational athletes of all ages. The anatomic and biomechanical complexity of the hip region often cause diagnostic uncertainty for the clinicians evaluating these injuries. Therefore, obtaining additional diagnostic information is often crucial for providing injured athletes with a prompt and accurate diagnosis so they can return to activity as soon as possible. Musculoskeletal ultrasound is becoming increasingly important in evaluating and treating sports-related injuries of the hip. EVIDENCE ACQUISITION The PubMed database was searched in May of 2013 for English-language articles pertaining to sonography of sports injuries of the hip using the following keywords in various combinations: musculoskeletal, ultrasound, hip, hip sonography, and sports. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS Musculoskeletal ultrasound is currently being used for both diagnosis and treatment in a wide range of acute and chronic conditions affecting the hip, including tendinosis, tendon/muscle strains, ligamentous sprains, enthesopathies, growth plate injuries, fractures, bursitis, effusions, synovitis, labral tears, and snapping hip. Therapeutically, it is used to guide injections, aspirations, and biopsies. CONCLUSION Musculoskeletal ultrasound use is expanding and will likely continue to do so as more clinicians realize its capabilities. Characteristics, including accessibility, portability, noninvasiveness, dynamic examination, power Doppler examination, and low cost highlight the potential of ultrasound.
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Affiliation(s)
| | - Peter H Seidenberg
- Penn State Hershey Bone and Joint Institute, State College, Pennsylvania ; Penn State University, State College, Pennsylvania
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Ultrasound of the Thigh: Focal, Compartmental, or Comprehensive Examination? AJR Am J Roentgenol 2014; 203:1085-92. [DOI: 10.2214/ajr.13.12286] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Drew MK, Osmotherly PG, Chiarelli PE. Imaging and clinical tests for the diagnosis of long-standing groin pain in athletes. A systematic review. Phys Ther Sport 2014; 15:124-9. [DOI: 10.1016/j.ptsp.2013.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 09/20/2013] [Accepted: 11/06/2013] [Indexed: 12/22/2022]
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Robinson P, Grainger AJ, Hensor EMA, Batt ME, O'Connor PJ. Do MRI and ultrasound of the anterior pelvis correlate with, or predict, young football players’ clinical findings? A 4-year prospective study of elite academy soccer players. Br J Sports Med 2014; 49:176-82. [DOI: 10.1136/bjsports-2013-092932] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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A European survey on the aetiology, investigation and management of the "sportsman's groin". Hernia 2013; 18:803-10. [PMID: 24249070 DOI: 10.1007/s10029-013-1178-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 10/31/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION A sportsman's groin has no accepted definition or consensus on treatment. The aim of this study was to assess current opinion among a large body of European surgeons using an online survey. METHODS An online questionnaire comprising 16 multiple-choice questions was sent by email to general surgeons in Europe. The survey was live from the 6th to 30th September 2011. RESULTS In total 143 responses were received. One hundred and six respondents (74 %) expressed experience in managing this condition. The majority (91 %) managed <26 cases per year. Posterior wall weakness (53 %), pubic tendinitis (43 %), nerve entrapment (37 %) and conjoint tendon injury (36 %) were the commonest aetiological factors described. Preferred diagnostic investigations were ultrasound of the groin (44 %) and MRI of the pelvis (29 %). The most common initial treatment (91 % of respondents) was conservative measures (rest and analgesia) for a maximum of 6-month period. When surgery was undertaken, Lichtenstein repair (29 %), TEP (27 %), TAPP (20 %), and posterior wall repair (21 %) were the commonest procedures. The majority (95 %) of respondents would not offer bilateral surgery for those presenting with unilateral groin pain. CONCLUSIONS Most European surgeons see <26 cases of "sportsman's groin" per year, which is in keeping with the low incidence of this condition. There remains wide variation in its investigation and management, which reflects the differences in opinion on its aetiology. The majority of surgeons agree that surgery is not the only treatment option available, but there is little consensus on the optimal management.
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Sheen AJ, Stephenson BM, Lloyd DM, Robinson P, Fevre D, Paajanen H, de Beaux A, Kingsnorth A, Gilmore OJ, Bennett D, Maclennan I, O'Dwyer P, Sanders D, Kurzer M. ‘Treatment of the Sportsman's groin’: British Hernia Society's 2014 position statement based on the Manchester Consensus Conference. Br J Sports Med 2013; 48:1079-87. [DOI: 10.1136/bjsports-2013-092872] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hölmich P, Thorborg K, Dehlendorff C, Krogsgaard K, Gluud C. Incidence and clinical presentation of groin injuries in sub-elite male soccer. Br J Sports Med 2013; 48:1245-50. [PMID: 23956334 DOI: 10.1136/bjsports-2013-092627] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Groin injuries cause major problems in the football codes, as they are prevalent and lead to prolonged symptoms and high recurrence. The aim of the present study was to describe the occurrence and clinical presentation of groin injuries in a large cohort of sub-elite soccer players during a season. METHODS Physiotherapists allocated to each of the participating 44 soccer clubs recorded baseline characteristics and groin injuries sustained by a cohort of 998 sub-elite male soccer players during a full 10-month season. All players with groin injuries were examined using the clinical entity approach, which utilises standardised reproducible examination techniques to identify the injured anatomical structures. The exposure time and the injury time were also recorded. Injury time was analysed using multiple regression on the log of the injury times as the data were highly skewed. Effects are thus reported at relative injury time (RIT). RESULTS Adductor-related groin injury was the most common entity found followed by iliopsoas-related and abdominal-related injuries. The dominant leg was significantly more often injured. Age and previous groin injury were significant risk factors for sustaining a groin injury. Groin injuries were generally located on the same side as previously reported groin injuries. Adductor-related injuries with no abdominal pain had significantly longer injury times compared to injuries with no adductor and no abdominal pain (RIT 2.28, 95% CI 1.22 to 4.25, p=0.0096). Having both adductor and abdominal pain also increased the injury time significantly when compared to injuries with no adductor and no abdominal pain (RIT=4.56, 95% CI 1.91 to 10.91, p=0.001). CONCLUSION Adductor-related groin injury was the most common clinical presentation of groin injuries in male soccer players and the cause of long injury time, especially when combined with abdominal-related injury.
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Affiliation(s)
- Per Hölmich
- Arthroscopic Center Amager, Sports Orthopaedic Research Center - Copenhagen, Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark Aspetar Sports Groin Pain Center, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Kristian Thorborg
- Arthroscopic Center Amager, Sports Orthopaedic Research Center - Copenhagen, Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark
| | - Christian Dehlendorff
- Arthroscopic Center Amager, Sports Orthopaedic Research Center - Copenhagen, Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kim Krogsgaard
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Imaging assessment of groin pain. Musculoskelet Surg 2013; 97 Suppl 2:S109-16. [PMID: 23949932 DOI: 10.1007/s12306-013-0278-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 06/10/2013] [Indexed: 10/26/2022]
Abstract
Groin pain is a common condition in athletes, especially those who play certain sports, for instance soccer, ice hockey, fencing which request rapid acceleration and frequent changes of movement. This condition represents a diagnostic difficulty for the radiologist due to either the anatomical pubic region complexity than the many causes that can be a source of pain, because the groin pain can be determined by conditions affecting the bony structures, cartilage and muscle tendons that are part of the proper pubis but also from those involving the hip. The approach to the groin through diagnostic imaging is multidisciplinary: The study of the patient is performed by traditional radiographs, ultrasound examination, magnetic resonance imaging or computed tomography, based on clinical suspicion, and each of these methods provides different results depending on the disease in question. The purpose of this article is to examine what are the optimal imaging techniques to investigate the various diseases affecting the patient with groin pain.
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Imaging of athletic pubalgia and core muscle injuries: clinical and therapeutic correlations. Clin Sports Med 2013; 32:427-47. [PMID: 23773876 DOI: 10.1016/j.csm.2013.03.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Athletes frequently injure their hips and core muscles. Accurate diagnosis and proper treatment of groin pain in the athlete can be tricky, frequently posing vexing problem for trainers and physicians. Clinical presentations of the various hip problems overlap with respect to history and physical examination. This article reviews clinical presentations and magnetic resonance imaging findings specific to the various causes of groin pain in the athlete. The focus is on the core muscle injuries (athletic pubalgia or "sports hernia"). The goal is to raise awareness about the variety of injuries that occur and therapeutic options.
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