1
|
Calatayud Moscoso Del Prado J, Fernández-Gil MÁ, Bueno Horcajadas Á, Kassarjian A. Groin pain in soccer players: anatomy, clinical presentation, biomechanics, pathology and imaging findings. Skeletal Radiol 2024:10.1007/s00256-024-04699-z. [PMID: 38787402 DOI: 10.1007/s00256-024-04699-z] [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: 09/24/2023] [Revised: 04/10/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024]
Abstract
Groin pain is extremely common in soccer players, especially male soccer players, with nearly a third experiencing groin pain over the course of their careers. Despite its high prevalence, there continues to be some confusion and controversy regarding the detailed anatomy and recommended terminology related to groin pain in athletes. This article will review the anatomy, clinical presentation, biomechanics, pathology and imaging findings most commonly associated with groin pain in soccer players.
Collapse
Affiliation(s)
| | - María Ángeles Fernández-Gil
- Olympia Medical Center, Torre Caleido, Paseo de La Castellana 259 E, 28046, Madrid, Spain
- Elite Sport Imaging, SL, Madrid, Spain
| | - Ángel Bueno Horcajadas
- Olympia Medical Center, Torre Caleido, Paseo de La Castellana 259 E, 28046, Madrid, Spain
- Elite Sport Imaging, SL, Madrid, Spain
| | - Ara Kassarjian
- Olympia Medical Center, Torre Caleido, Paseo de La Castellana 259 E, 28046, Madrid, Spain
- Elite Sport Imaging, SL, Madrid, Spain
| |
Collapse
|
2
|
Salman R, Albar A, Kan JH. MR imaging spectrum of adolescent pubic symphyseal injuries/athletic pubalgia. Pediatr Radiol 2024:10.1007/s00247-024-05946-0. [PMID: 38736018 DOI: 10.1007/s00247-024-05946-0] [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: 01/24/2024] [Revised: 05/03/2024] [Accepted: 05/06/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) findings associated with athletic pubalgia are well documented in the adult literature. OBJECTIVE To describe the spectrum of MRI findings in adolescents with pubic symphyseal injuries/athletic pubalgia. MATERIALS AND METHODS This is an institutional review board approved, retrospective study of all patients < 18 years who were referred for MRI, over the last 10 years. Two pediatric musculoskeletal radiologists evaluated the MRI in consensus for the following findings: Chronic Salter-Harris (SH)-I equivalent fracture or asymmetric parasymphyseal ossific fraying, non-retractile muscular tear or retraction, and edema of the aponeurosis and arcuate ligament. Radiographs were also reviewed for Risser stage. RESULTS Fifteen patients were identified (100% male, median age 17 years, IQR 16-17.6). Most patients (14/15, 93%) had either asymmetric parasymphyseal ossific fraying (4/15, 27%) or chronic SH-1 equivalent fracture (10/15, 67%) of the pubic symphysis, and all patients (15/15, 100%) had aponeurotic and arcuate ligament edema. Few patients had rectus abdominis muscular retraction (2/15, 13%), non-retractile muscular tear of the rectus abdominis (2/15, 13%), and/or adductor muscle (4/15, 27%). Risser stage was as follows: stages 0 (13%), 3 (7%), 4 (47%), and 5 (33%). The injuries in our limited data set were independent of skeletal maturity with no statistically significant association between any of the MRI findings and Risser stage. CONCLUSION The MR imaging spectrum of adolescent athletic pubalgia differs from the described findings in adults due to skeletal immaturity. The cleft sign described in adults manifests in adolescents as asymmetric parasymphyseal ossific fraying and chronic SH-1 equivalent fractures.
Collapse
Affiliation(s)
- Rida Salman
- Department of Radiology, The Ohio State University College of Medicine, Nationwide Children's Hospital, 700 Children's Dr, Columbus, 43205, OH, USA.
| | - Abeer Albar
- Department of Radiology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - J Herman Kan
- Edward B. Singleton Department of Radiology, Division of Body Imaging, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
3
|
Tharnmanularp S, Muro S, Nimura A, Ibara T, Akita K. Significant relationship between musculoaponeurotic attachment of the abdominal and thigh adductor muscles to the pubis: implications for the diagnosis of groin pain. Anat Sci Int 2024; 99:190-201. [PMID: 37985575 PMCID: PMC10902015 DOI: 10.1007/s12565-023-00750-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/28/2023] [Indexed: 11/22/2023]
Abstract
Groin pain is prevalent in orthopedic and sports medicine, causing reduced mobility and limiting sports activity. To effectively manage groin pain, understanding the detailed anatomy of supporting muscles is crucial. This study aimed to investigate the musculoaponeurotic attachments on the pubis and the relationship among intramuscular aponeuroses of abdominal and thigh adductor musculatures. Macroscopic analyses were performed in 10 pelvic halves. The bone morphology of the pubis was assessed in two pelvic halves using microcomputed tomography. Histological investigations were conducted in two pelvic halves. The external oblique aponeurosis extended to the adductor longus aponeurosis, forming conjoined aponeurosis, which attached to a small impression distal to the pubic crest. The gracilis aponeurosis merges with the adductor brevis aponeurosis and is attached to the proximal part of the inferior pubic ramus. The rectus abdominis and pyramidalis aponeuroses were attached to the pubic crest and intermingled with the gracilis-adductor brevis aponeurosis, forming bilateral conjoined aponeurosis, which attached to a broad area covering the anteroinferior surface of the pubis. Histologically, these two areas of conjoined aponeuroses were attached to the pubis via the fibrocartilage enthesis. Microcomputed tomography revealed two distinctive bone morphologies, a small impression and an elongated osseous prominence on pubis, corresponded to the two areas of conjoined aponeuroses. This study demonstrated close relationships between the aponeurotic attachment of the external oblique and adductor longus, and between the rectus abdominis, pyramidalis, gracilis, and adductor brevis. The findings of aponeurotic complexes would aid in diagnostic and surgical approaches for athletic groin pain.
Collapse
Affiliation(s)
- Suthasinee Tharnmanularp
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Satoru Muro
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan.
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Takuya Ibara
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| |
Collapse
|
4
|
Pedrinelli A, de Castro Fernandes JV, Dorilêo Leite Filho CG, Marques de Almeida A, Lazzaretti Fernandes T, Hernandez AJ. Optimised return to play: high treatment success rate in core muscle injury with surgical release of the anterior tendon of the rectus abdominis muscle and proximal tenotomy of the adductor longus muscle. J ISAKOS 2024; 9:16-24. [PMID: 37931748 DOI: 10.1016/j.jisako.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/19/2023] [Accepted: 10/30/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES Core muscle injury is a debilitating condition that causes chronic groin pain in athletes, particularly common in soccer players. The condition is characterised by pain in the inguinal region and can lead to a significant number of absences from high-intensity physical activity. It is caused by repetitive overload without proper counterbalance from the abdominal muscles, hip flexors, and adductors in susceptible athletes. Surgical indications for core muscle injury consider cases where non-surgical treatments have not provided sufficient relief. The aim of this study was to assess the results of surgical intervention for core muscle injury using the technique employed by the Sports Medicine Group of (Institute of Orthopedics and Traumatology of Hospital das Clínicas - Universidade de São Paulo). The procedure involves releasing the anterior portion of the tendon of the rectus abdominis muscle near the pubic symphysis, along with proximal tenotomy of the adductor longus muscle tendon. METHODS This study utilised a consecutive historical cohort analysis of the medical records of 45 male athletes, of which, 75.6% were professional soccer players, who underwent surgical treatment between January 1, 2002, and December 31, 2021. The participants included active athletes aged between 18 and 40 years, with a mean age of 23.9 years, and were diagnosed with myotendinous core muscle injury. These athletes experienced pain in the pubic symphysis and adductor tendon region and had previously undergone medical treatment and physical therapy for a duration of three to six months without significant improvement. RESULTS The average time for athletes to return to sport after surgery was 135 days, with a majority of participants being soccer and futsal players. The surgical intervention yielded promising results, with a positive correlation between unilateral injuries and the time taken to return to sport. The complication rate was low, at 6.7%. Notably, the rate of symptom resolution was high, at 93.3%. Furthermore, the analysis indicated that the player's position on the field significantly influenced the discharge period, suggesting that the game position plays a role in the recovery process. CONCLUSION The combined surgical procedure involving the release of the rectus abdominis tendon and adductor longus muscle tenotomy demonstrates favourable outcomes for athletes with core muscle injury. This study provides strong support for the effectiveness of this surgical approach in managing the condition and offers a potential path to recovery and return to sports activities. LEVEL OF EVIDENCE: 4 STUDY DESIGN Cross-sectional study.
Collapse
Affiliation(s)
- Andre Pedrinelli
- Sports Division, Institute of Orthopedics and Traumatology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo (IOT HC FMUSP), São Paulo, 05403902, Brazil
| | - João Vitor de Castro Fernandes
- Sports Division, Institute of Orthopedics and Traumatology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo (IOT HC FMUSP), São Paulo, 05403902, Brazil.
| | - Carlos Guilherme Dorilêo Leite Filho
- Sports Division, Institute of Orthopedics and Traumatology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo (IOT HC FMUSP), São Paulo, 05403902, Brazil
| | - Adriano Marques de Almeida
- Sports Division, Institute of Orthopedics and Traumatology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo (IOT HC FMUSP), São Paulo, 05403902, Brazil
| | - Tiago Lazzaretti Fernandes
- Sports Division, Institute of Orthopedics and Traumatology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo (IOT HC FMUSP), São Paulo, 05403902, Brazil
| | - Arnaldo Jose Hernandez
- Sports Division, Institute of Orthopedics and Traumatology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo (IOT HC FMUSP), São Paulo, 05403902, Brazil
| |
Collapse
|
5
|
C P O'N, E L G, A J G. Ultrasound imaging in professional soccer: when is it adequate? Skeletal Radiol 2023:10.1007/s00256-023-04551-w. [PMID: 38151516 DOI: 10.1007/s00256-023-04551-w] [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: 08/01/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 12/29/2023]
Abstract
Ultrasound imaging plays an important role in the diagnosis, monitoring and treatment of injuries in professional soccer players. With the rapid increase in the availability of hand-held portable ultrasound devices and the pressure to make timely and accurate diagnosis in professional soccer where return to play time is crucial, ultrasound imaging is an essential diagnostic tool. In this article, we discuss examples of injuries that can be adequately assessed by ultrasound imaging alone and injuries where ultrasound imaging provides a useful first step to guide further investigation and management.
Collapse
Affiliation(s)
- O 'Neill C P
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Gerety E L
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Grainger A J
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| |
Collapse
|
6
|
O'Donnell R, DeFroda S, Bokshan SL, Levins JG, Hulstyn MJ, Tabaddor RR. Cadaveric Analysis of Key Anatomic Structures of Athletic Pubalgia. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202306000-00008. [PMID: 37319366 PMCID: PMC10270532 DOI: 10.5435/jaaosglobal-d-23-00070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/24/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE This study proposes to establish in-depth inspection of the anatomic structures involved with the pathology of athletic pubalgia in a cadaver model. METHODS Eight male fresh frozen cadavers were dissected in a layered fashion. The rectus abdominis (RA) and adductor longus (AL) tendon insertions were isolated to quantify the size of the anatomic footprint and distance from the surrounding anatomy. RESULTS The RA insertional footprint was 1.65 cm (SD, 0.18) in width by 1.02 cm (SD, 0.26) in length, and the AL insertional footprint on the underside of the pubis was 1.95 cm (SD, 0.28) in length by 1.23 cm (SD, 0.33) in width. The ilioinguinal nerve was 2.49 cm (SD, 0.36) lateral to the center of the RA footprint and 2.01 cm (SD, 0.37) lateral to the center of the AL footprint. The spermatic cord and the genitofemoral nerve were just lateral to the ilioinguinal nerve and were 2.76 cm (SD, 0.44) and 2.66 cm (SD, 0.46) from the rectus and AL footprints, respectively. CONCLUSION Surgeons should be cognizant of these anatomic relations during both initial dissection and tendon repair to optimize repair and avoid iatrogenic injury to critical structures in the anterior pelvis.
Collapse
Affiliation(s)
- Ryan O'Donnell
- From the Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI
| | | | | | | | | | | |
Collapse
|
7
|
Baal JD, Cecil KL, Patel R, O'Brien M, McGill K, Link TM. Imaging of Overuse Injuries of the Hip. Radiol Clin North Am 2023; 61:191-201. [PMID: 36739141 DOI: 10.1016/j.rcl.2022.10.003] [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: 12/15/2022]
Abstract
Overuse injuries of the hip are common, and clinical diagnosis may be difficult because of overlapping and nonspecific clinical symptoms. Imaging can play an essential role in guiding diagnosis and management. Femoroacetabular joint structural abnormalities result in various conditions that can predispose patients to early development of osteoarthritis. Repetitive stress on the skeletally immature hip can result in apophyseal injuries. Notable nonosseous overuse hip pathologies include athletic pubalgia, trochanteric bursitis, and injuries involving the iliopsoas myotendinous unit. Timely diagnosis of overuse injuries of the hip can facilitate improved response to conservative measures and prevent irreversible damage.
Collapse
Affiliation(s)
- Joe D Baal
- Department of Radiology and Biomedical Imaging, University of California, 400 Parnassus Avenue, Box 0628, San Francisco, CA 94143, USA
| | - Katherine L Cecil
- Department of Radiology and Biomedical Imaging, University of California, 400 Parnassus Avenue, Box 0628, San Francisco, CA 94143, USA
| | - Rina Patel
- Department of Radiology and Biomedical Imaging, University of California, 400 Parnassus Avenue, Box 0628, San Francisco, CA 94143, USA
| | - Matthew O'Brien
- Diagnostic Radiology, Oregon Health & Science University, L340, 3181 SW Sam Jackson Park Road Portland, OR 97239, USA
| | - Kevin McGill
- Department of Radiology and Biomedical Imaging, University of California, 400 Parnassus Avenue, Box 0628, San Francisco, CA 94143, USA
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California, 400 Parnassus Avenue, Box 0628, San Francisco, CA 94143, USA.
| |
Collapse
|
8
|
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.
Collapse
Affiliation(s)
- Marc-André Weber
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland.
| |
Collapse
|
9
|
Broos WAM, van der Zant FM, Knol RJJ. Athletic Osteitis Pubis Detected on 18 F-FDG PET/CT. Clin Nucl Med 2022; 47:822-823. [PMID: 35452006 DOI: 10.1097/rlu.0000000000004243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT A 37-year-old male personal trainer presented with debilitating groin pains, fever, and night sweats. Enlarged inguinal lymph nodes were noticed during physical examination, and blood tests showed elevated erythrocyte sedimentation rate and C-reactive protein. 18 F-FDG PET/CT excluded lymphoma and other malignancy but showed intense FDG uptake at the pubic symphysis and cortical erosions of the pubic bones on CT. The patient was diagnosed with osteitis pubis, an inflammatory condition of the pubic symphysis commonly seen in athletes. Treatment with anti-inflammatory drugs was initiated. Within several weeks, pain decreased, and inflammatory markers normalized.
Collapse
Affiliation(s)
- Wouter A M Broos
- From the Department of Nuclear Medicine, Northwest Clinics, Alkmaar, the Netherlands
| | | | | |
Collapse
|
10
|
Postoperative MR Imaging of the Pubic Symphysis and Athletic Pubalgia. Magn Reson Imaging Clin N Am 2022; 30:689-702. [DOI: 10.1016/j.mric.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
11
|
Hynes JP, O'Flaherty M, Glynn D, Eustace S, Kavanagh EC. Imaging of groin pain in athletes: patterns of injury at MRI and gender differences therein. Ir J Med Sci 2022:10.1007/s11845-022-03126-3. [PMID: 35971036 DOI: 10.1007/s11845-022-03126-3] [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: 06/14/2022] [Accepted: 08/05/2022] [Indexed: 10/15/2022]
Abstract
AIM The purpose of our study was to review a large cohort of athletes of all levels presenting with groin pain who underwent investigation with MRI and to determine what the commonest patterns of injury were. We aimed to explore whether particular findings were commonly found in association and whether measurable gender differences exist in the incidence of specific injuries. MATERIALS AND METHODS Imaging records were reviewed to identify MRI studies of the pelvis performed for the investigation of groin pain in patients who were active in sports/athletic pursuits. Findings were classified and recorded as follows: injury to the common rectus abdominis/adductor longus origin, injury to the short adductor muscles, pubic bone oedema, pubic symphysis degenerative changes, hip joint injury and 'other'. The prevalence of specific injuries in female athletes compared to males was analysed using relative risk ratios. RESULTS A total of 470 athletes underwent MRI for the investigation of groin pain during the study period. Forty-six were female, and 424 were male. Female athletes were significantly less likely to have rectus abdominis-adductor longus (RR = 0.31, p = .017), short adductor (RR = 0.14, p = .005) or hip (RR = 0.41, p = .003) injuries. Pubic bone degenerative changes were much more common in female athletes (RR = 7.37, p = .002). CONCLUSION Significant gender differences exist in the frequency with which specific injuries are observed. Female athletes are also significantly underrepresented; this is likely a multifactorial phenomenon; however, the possibility of unconscious referrer bias must be considered.
Collapse
Affiliation(s)
- John P Hynes
- Department of Radiology, National Orthopaedic Hospital of Ireland, Cappagh, Dublin, Ireland. .,Mater Misericordiae University Hospital, Dublin, Ireland.
| | | | - David Glynn
- Department of Radiology, National Orthopaedic Hospital of Ireland, Cappagh, Dublin, Ireland.,Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sarah Eustace
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Eoin C Kavanagh
- Department of Radiology, National Orthopaedic Hospital of Ireland, Cappagh, Dublin, Ireland.,Mater Misericordiae University Hospital, Dublin, Ireland
| |
Collapse
|
12
|
Flores DV, Umpire DF, Sampaio ML, Cresswell ME, Pathria MN. US and MRI of Pelvic Tendon Anatomy and Pathologic Conditions. Radiographics 2022; 42:1433-1456. [PMID: 35960665 DOI: 10.1148/rg.220055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The bony pelvis serves as the attachment site for a large number of powerful muscles and tendons that drive lower extremity movement. Organizing the pelvic tendons into groups that share a common function and anatomic location helps the radiologist systematically evaluate these structures for injury, which can be caused by repetitive stress, acute trauma, or failure of degenerated tissues. Tears of the anteromedial adductors around the pubic symphysis and anterior flexors traversing anterior to the hip principally affect younger male athletes. Tears of the lateral abductors and posterior extensors are more common in older individuals with senescent tendinosis. The deep external rotators are protected and rarely injured, although they can be impinged. Imaging of the pelvic tendons relies primarily on US and MRI; both provide high spatial and contrast resolution for soft tissues. US offers affordable point-of-care service and dynamic assessment, while MRI allows simultaneous osseous and articular evaluation and is less operator dependent. While the imaging findings of pelvic tendon injury mirror those at appendicular body sites, radiologists may be less familiar with tendon anatomy and pathologic conditions at the pelvis. The authors review pertinent anatomy and imaging considerations and illustrate common injuries affecting the pelvic tendons. Online supplemental material is available for this article. ©RSNA, 2022.
Collapse
Affiliation(s)
- Dyan V Flores
- From the Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., M.L.S.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (M. E.C.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
| | - Darwin Fernández Umpire
- From the Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., M.L.S.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (M. E.C.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
| | - Marcos Loreto Sampaio
- From the Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., M.L.S.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (M. E.C.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
| | - Mark Edward Cresswell
- From the Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., M.L.S.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (M. E.C.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
| | - Mini N Pathria
- From the Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., M.L.S.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (M. E.C.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
| |
Collapse
|
13
|
Gowd AK, Beck EC, Trammell AP, Edge C, Stubbs AJ. Evaluation of additional causes of hip pain in patients with femoroacetabular impingement syndrome. Front Surg 2022; 9:697488. [PMID: 36034352 PMCID: PMC9399470 DOI: 10.3389/fsurg.2022.697488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
Femoroacetabular impingement syndrome (FAIS) is an increasingly prevalent pathology in young and active patients, that has contributing factors from both abnormal hip morphology as well as abnormal hip motion. Disease progression can be detrimental to patient quality of life in the short term, from limitations on sport and activity, as well as the long term through early onset of hip arthritis. However, several concurrent or contributing pathologies may exist that exacerbate hip pain and are not addressed by arthroscopic intervention of cam and pincer morphologies. Lumbopelvic stiffness, for instance, places increased stress on the hip to achieve necessary flexion. Pathology at the pubic symphysis and sacroiliac joint may exist concurrently to FAIS through aberrant muscle forces. Additionally, both femoral and acetabular retro- or anteversion may contribute to impingement not associated with traditional cam/pincer lesions. Finally, microinstability of the hip from either osseous or capsuloligamentous pathology is increasingly being recognized as a source of hip pain. The present review investigates the pathophysiology and evaluation of alternate causes of hip pain in FAIS that must be evaluated to optimize patient outcomes.
Collapse
|
14
|
Athanasiou V, Ampariotou A, Lianou I, Sinos G, Kouzelis A, Gliatis J. Osteitis Pubis in Athletes: A Literature Review of Current Surgical Treatment. Cureus 2022; 14:e22976. [PMID: 35464551 PMCID: PMC9001088 DOI: 10.7759/cureus.22976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 11/05/2022] Open
Abstract
Osteitis pubis (OP) is a self-limiting, noninfectious inflammatory disease of the pubic symphysis and the surrounding soft tissues that usually improves with activity modification and targeted conservative treatment. Surgical treatment is required for a limited number of patients. This study aims to investigate the current literature on the surgical treatment of OP in athletes. A systematic review was conducted on two databases (MEDLINE/PubMed and Google Scholar) from 2000 to 2021. The inclusion criteria were adult patients with athletic OP who underwent surgical treatment and studies published in English. The exclusion criteria included pregnancy, infection OP, or postoperative complications related to other surgical interventions, such as urological or gynecological complications. Fifty-one surgically treated cases have been reported in eight studies, which included short-term, mid-term, and long-term studies ranging from one patient to 23 patients. The surgical treatment methods were as follows: (a) pubic symphysis arthrodesis, (b) open or endoscopic pubic symphysectomy, (c) wedge resection of the pubic symphysis, and (d) polypropylene mesh placed into the preperitoneal retropubic space endoscopically. The main indication for surgical intervention was failure of conservative measures and long-lasting pain, disability, and inability to participate in athletic activities. Wedge resection of the pubic symphysis has been the less preferred surgical treatment in the recently published literature. The most common surgical method of treatment of OP in athletes, which entailed the existence of posterior stability of the sacroiliac joint, in the current literature is open pubic symphysis curettage. Recently, there has been a tendency for pubic symphysis curettage to be performed endoscopically.
Collapse
|
15
|
Poor AE, Warren A, Zoga AC, Meyers WC, Roedl JB. Ultrasound-guided Procedures Allow Delay of Definitive Treatment for Core Muscle Injuries. Med Sci Sports Exerc 2022; 54:206-210. [PMID: 34559722 DOI: 10.1249/mss.0000000000002785] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Core muscle injuries (CMI) are common in every sport. To minimize lost playing time, providers apply various nonsurgical treatments, including platelet-rich plasma, corticosteroids, ultrasound (US)-guided percutaneous tenotomy, and prolotherapy. Limited data exist with regard to their effectiveness. We chose to review a cohort of consecutive professional and collegiate athletes who sustained CMI at various points within their seasons and underwent a combination of US-guided percutaneous needle "tenotomy" and corticosteroid injections to complete the remainder of their seasons. METHODS Twenty-five consecutive collegiate or professional athletes with CMI involving the rectus abdominis-adductor aponeurotic plate were included in this retrospective study. Athletes with concomitant symptomatic hip femoroacetabular impingement were included in the study. The primary outcome measure was whether athletes completed their seasons. Secondary measures were weeks played after the procedures (delay until surgery), need for repeat procedures, and outcomes after eventual surgery. Postoperative performance was assessed via interviews at 6 wk and 6 months postoperatively. RESULTS Twenty-one of 25 (84%) athletes completed their seasons. On average, athletes returned to play 3 d (range, 1-9 d) after the procedures. Surgical repair was delayed a mean of 18 wk (range, 2-44 wk). Seven athletes had concomitant symptomatic femoroacetabular impingement and six underwent combined hip arthroscopy and core muscle repairs. Among 17 patients who eventually had core muscle surgery alone (no hip surgery), 82% (14 of 17) reported performing at their preinjury level at 6 wk. At 6 months, 96% of postop athletes (22 of 23) reported performing at their preinjury level. CONCLUSIONS Temporizing CMI with US-guided percutaneous tenotomy and corticosteroid injections is effective in allowing continued sport participation among high-level athletes and does not negatively affect postoperative outcomes.
Collapse
Affiliation(s)
| | | | - Adam C Zoga
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA
| | | | - Johannes B Roedl
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA
| |
Collapse
|
16
|
RODRIGUES FERNANDOMANSANO, TANEJA ATULKUMAR, NARAHASHI ERICA, SILVA FLAVIODUARTE, FERNANDES ARTURROCHACORRÊA, FALOTICO GUILHERMEG, YAMADA ANDRÉFUKUNISHI. PELVIC INCIDENCE AND OSTEITIS PUBIS IN PROFESSIONAL SOCCER PLAYERS. ACTA ORTOPEDICA BRASILEIRA 2022; 30:e244380. [PMID: 35431631 PMCID: PMC8979358 DOI: 10.1590/1413-785220223001e244380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/10/2021] [Indexed: 05/31/2023]
Abstract
Introduction. Osteitis pubis is a common inflammatory disease of the pubic symphysis, defined as a chronic pain syndrome caused by repetitive microtrauma. Since adaptative changes are necessary in the pelvis to adjust the equilibrium of the myotendinous structures, the aim of this study was to evaluate the correlation between pelvic incidence and osteitis pubis among professional soccer players. Materials and Methods. An observational, cross-sectional study was performed with professional soccer players from five teams during pre-season. Athletes with previous congenital pelvic abnormalities or a history of surgery were excluded. Radiographs of the pelvis were analyzed by two radiologists and assessed for findings consistent with osteitis pubis, and the following parameters were measured: pelvic incidence (PI), sacral inclination (SI), and pelvic version (PV). Results. A total of 107 subjects were included in the study, with a mean age of 25.6 ± 3.1 years. Findings compatible with osteitis pubis were present in 74.8% of the subjects (80/107). There was no statistical correlation between osteitis pubis and PI (52.3°±12.7° vs. 48.4°±10.8°; p=0.156), SI (43.1°±9.8° vs. 39.9°±10.1°; p=0.146), or PV (9.2°± 6.3° vs 8.6°± 7.5°; p=0.649). Agreement between readers was excellent (p<0.0001). Conclusion. There was no significant correlation between pelvic parameters and radiographic diagnosis of osteitis pubis. Leve of Evidence II; Diagnostic study.
Collapse
Affiliation(s)
| | - ATUL KUMAR TANEJA
- Hospital do Coração, Brazil; Hospital Israelita Albert Einstein, Brazil
| | | | | | | | | | - ANDRÉ FUKUNISHI YAMADA
- Universidade Federal de São Paulo, Brazil; Hospital do Coração, Brazil; Diagnósticos da América SA, Brazil
| |
Collapse
|
17
|
Galano GJ, Tyler TF, Stubbs T, Ashraf A, Roberts M, McHugh MP, Zoland MP, Nicholas SJ. Resisted adduction sit-up test (RASUT) as a screening tool for pelvic versus hip pathology. J Hip Preserv Surg 2021; 8:331-336. [PMID: 35505809 PMCID: PMC9052402 DOI: 10.1093/jhps/hnab075] [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: 07/02/2021] [Revised: 09/29/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022] Open
Abstract
Groin pain is a common symptom in hip and pelvic pathology and differentiating between the two remains a challenge. The purpose of this study was to examine whether a test combining resisted adduction with a sit-up (RASUT) differentiates between pelvic and hip pathology. The RASUT was performed on 160 patients with complaints of hip or groin pain who subsequently had their diagnosis confirmed by magnetic resonance imaging (MRI) or surgery. Patients were categorized as having pelvic pathology (athletic pubalgia or other) or hip pathology (intra-articular or other). Athletic pubalgia was defined as any condition involving the disruption of the pubic aponeurotic plate. Sensitivity, specificity, positive predictive accuracy, negative predictive accuracy and diagnostic odds ratios were computed. Seventy-one patients had pelvic pathology (40 athletic pubalgia), 81 had hip pathology and 8 had both. The RASUT was effective in differentiating pelvic from hip pathology; 50 of 77 patients with a positive RASUT had pelvic pathology versus 29 of 83 patients with a negative test (P < 0.001). RASUT was diagnostic for athletic pubalgia (diagnostic odds ratio 6.08, P < 0.001); 35 of 45 patients with athletic pubalgia had a positive RASUT (78% sensitivity) and 73 of 83 patients with a negative RASUT did not have athletic pubalgia (88% negative predictive accuracy). The RASUT can be used to differentiate pelvic from hip pathology and to identify patients without athletic pubalgia. This is a valuable screening tool in the armamentarium of the sports medicine clinician.
Collapse
Affiliation(s)
- Gregory J Galano
- New York Orthopedics, 159 East 74 Street, New York, NY 10021, USA
| | - Timothy F Tyler
- Nicholas Institute of Sports Medicine and Athletic Trauma, MEETH, Lenox Hill Hospital, 210 East 64 Street, New York, NY 10075, USA
- Professional Physical Therapy, 2 Overhill Road, Scarsdale, NY 10583, USA
| | - Trevor Stubbs
- Nicholas Institute of Sports Medicine and Athletic Trauma, MEETH, Lenox Hill Hospital, 210 East 64 Street, New York, NY 10075, USA
| | - Ali Ashraf
- Nicholas Institute of Sports Medicine and Athletic Trauma, MEETH, Lenox Hill Hospital, 210 East 64 Street, New York, NY 10075, USA
| | - Michael Roberts
- Nicholas Institute of Sports Medicine and Athletic Trauma, MEETH, Lenox Hill Hospital, 210 East 64 Street, New York, NY 10075, USA
| | - Malachy P McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma, MEETH, Lenox Hill Hospital, 210 East 64 Street, New York, NY 10075, USA
| | - Mark P Zoland
- Department of Surgery, Lenox Hill Hospital, 130 East 77 Street, New York, NY 10075, USA
| | - Stephen J Nicholas
- New York Orthopedics, 159 East 74 Street, New York, NY 10021, USA
- Nicholas Institute of Sports Medicine and Athletic Trauma, MEETH, Lenox Hill Hospital, 210 East 64 Street, New York, NY 10075, USA
| |
Collapse
|
18
|
Dempsey PJ, Power JW, MacMahon PJ, Eustace S, Kavanagh EC. Nomenclature for groin pain in athletes. Br J Radiol 2021; 94:20201333. [PMID: 34328792 DOI: 10.1259/bjr.20201333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Currently, there is much variation in the terminology used to describe groin pain in athletes. Several groups have attempted to reach consensus on nomenclature in this area. This article outlines the current status of groin pain nomenclature for the radiologist, highlighting inherent heterogeneity, recent attempts to reach a consensus, the need for a radiological consensus and why imprecise terminology should be avoided when reporting.
Collapse
Affiliation(s)
- Philip J Dempsey
- Radiology Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Jack W Power
- Radiology Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Peter J MacMahon
- Radiology Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Steven Eustace
- Radiology Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Eoin C Kavanagh
- Radiology Department, Mater Misericordiae University Hospital, Dublin, Ireland
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Saito M, Niga S, Nihei T, Uomizu M, Ikezawa Y, Tsukada S. The cleft sign may be an independent factor of magnetic resonance imaging findings associated with a delayed return-to-play time in athletes with groin pain. Knee Surg Sports Traumatol Arthrosc 2021; 29:1474-1482. [PMID: 33452578 DOI: 10.1007/s00167-020-06410-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 12/07/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate the prevalence of magnetic resonance imaging (MRI) findings and define prognostic factors of the return-to-play time in young athletes with groin pain. METHODS A total of 1091 consecutive athletes were retrospectively screened; 651 athletes, aged 16-40 years, with pain in the groin regions were assessed using MRI. Of these athletes, 356 were included for analysing the time to return-to-play. Univariate and multiple linear regression analyses were used to determine the associations between the time to return-to-play (primary outcome variable) and the following variables: age, sex, body mass index, type of sports, Hip Sports Activity Scale, clear trauma history, and 12 MRI findings. RESULTS Four MRI findings, including cleft sign, pubic bone marrow oedema of both the superior and inferior ramus, and central disc protrusion of the pubic symphysis, appeared together in more than 44% of the cases. The median time to return-to-play was 24.7 weeks for athletes with a cleft sign on MRI, which was significantly longer than the 11.9 weeks for athletes without the sign. The median time to return-to-play was 20.8 weeks for athletes with BMI > 24, which was significantly longer than the 13.6 weeks for athletes with BMI ≦ 24. In multiple linear regression analysis of 356 athletes, in whom hip-related groin pain was excluded, and who were followed-up until the return-to-play, the body mass index and cleft sign were the independent factors associated with a delayed return-to-play. In contrast, iliopsoas muscle strain and other muscle injuries were associated with a shorter return-to-play. CONCLUSIONS Multiple MRI findings were present in almost half of all cases. Body mass index and the cleft sign were independently associated with a delayed return-to-play time in young athletes suffering from groin pain. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Masayoshi Saito
- Department of Orthopaedic Surgery, St. Luke's International Hospital, 9-1 Akashicho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Sadao Niga
- JIN Orthopaedic & Sports Clinic, 3-10-7 Suzuya, Chuo-ku, Saitama, Saitama, 338-0013, Japan.
| | - Tadahiro Nihei
- JIN Orthopaedic & Sports Clinic, 3-10-7 Suzuya, Chuo-ku, Saitama, Saitama, 338-0013, Japan
| | - Mari Uomizu
- Department of Orthopaedic Surgery, Nerima General Hospital, 1-24-1 Asahigaoka, Nerima-ku, Tokyo, 176-8530, Japan
| | - Yuji Ikezawa
- JIN Orthopaedic & Sports Clinic, 3-10-7 Suzuya, Chuo-ku, Saitama, Saitama, 338-0013, Japan
| | - Sachiyuki Tsukada
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, 3-2-1 Higashihara, Mito, Ibaraki, 310-0035, Japan
| |
Collapse
|
21
|
Abstract
Hip pain is a common complaint in athletes and can result in a significant amount of time lost from sport. Diagnosis of the source of hip pain can be a clinical challenge because of the deep location of the hip and the extensive surrounding soft tissue envelope. Establishing whether the source of hip pain is intra-articular or extra-articular is the first step in the process. A thorough history and a consistent and comprehensive physical examination are the foundation for the proper management of athletes with hip pain.
Collapse
Affiliation(s)
- Jacob G Calcei
- Department of Orthopaedic Surgery, University Hospitals of Cleveland, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA. https://twitter.com/drcalcei
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, CA, USA.
| |
Collapse
|
22
|
Femoroacetabular Impingement and Core Muscle Injury in Athletes: Diagnosis and Algorithms for Success. Sports Med Arthrosc Rev 2021; 29:9-14. [PMID: 33395224 DOI: 10.1097/jsa.0000000000000294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Athletic hip injuries account for a substantial portion of missed time from sports in high-level athletes. For both femoroacetabular impingement (FAI) and core muscles injuries, a thorough history and physical examination are paramount to guide the treatment. While advanced imaging including computed tomography and magnetic resonance imaging are frequently obtained, a wealth of information can be ascertained from standard radiographs alone. For patients with isolated or combined FAI and core muscle injuries (CMIs), the initial treatment is often nonoperative and consists of rest, activity modification, and physical therapy of the hips, core, and trunk. Injections may then aid in both confirming diagnosis and temporary symptom abatement. Arthroscopic procedures for refractory FAI in experienced hands have been shown to be both safe and efficacious. While surgical repair options for CMIs are significantly more variable, long-term studies have demonstrated the rapid resolution of symptoms and high return to play rates. More recently, anatomic and clinical correlations between FAI and CMIs have been identified. Special attention must be paid to elite athletes as the incidence of concurrent FAI with CMI is extremely high yet with significant symptom variability. Predictable return to play in athletes with coexisting symptomatic intra-articular and extra-articular symptomatology is incumbent upon the treatment of both pathologies.
Collapse
|
23
|
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.
Collapse
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
| |
Collapse
|
24
|
Koutserimpas C, Vlasis K, Makris MC, Ioannidis A, Konstantinidis MK, Antonakopoulos F, Athanasopoulos P, Mazarakis A, Papagelopoulos PJ, Konstantinidis KM. Operative treatment of athletic pubalgia in competitive athletes: a retrospective study. J Sports Med Phys Fitness 2020; 60:758-763. [PMID: 32438790 DOI: 10.23736/s0022-4707.20.10389-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Athletic pubalgia is an obscure sport injury, presenting mainly with groin pain during twisting movements. The present 15 year study reports outcomes, intraoperative findings and complications of the endoscopic surgical treatment in competitive athletes. METHODS All competitive athletes, from 2004 to 2018, suffering from athletic pubalgia, treated with laparoscopic Total Extra-Peritoneal technique, at the Department of General, Laparoscopic, Oncologic and Robotic Surgery of the Athens Medical Center were included in this retrospective cohort. Postoperative pain, complications, return to previous training routine and patients' satisfaction were evaluated. RESULTS A total of 130 patients (115; 88.5% males and 15; 11.5% females) with a mean age of 26.7±7.5 years were evaluated. Preoperatively, mean numeric scale pain was found to be 7.7±1.7. Three days postoperatively, the mean numeric pain scale was 3.4±1.5, showing 55.8% decrease. The mean time for return to sports activity was found to be 6.27±3.02 weeks. Regarding complications, six patients (4.6%) had slight numbness at the groin area during the first 6 postoperative months and one patient (0.8%) suffered from a postoperative hematoma. No recurrence was observed. At the final follow-up (mean 76.58±46.5 months), a total of 97 (74.7%) patients were very satisfied, 31 (23.8%) satisfied and two (1.5%) not satisfied with the outcome. CONCLUSIONS Laparoscopic operative treatment in competitive athletes suffering from athletic pubalgia seems to offer rapid recovery, rapid return to sports, as well as very low complications rate and no recurrence.
Collapse
Affiliation(s)
- Christos Koutserimpas
- Department of Orthopedics and Traumatology - .,Hellenic Air Force General Hospital, Athens, Greece -
| | | | - Marinos C Makris
- Department of Anatomy, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Argyrios Ioannidis
- Department of Anatomy, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael K Konstantinidis
- Department of Anatomy, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Fotios Antonakopoulos
- Department of Anatomy, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Athanasopoulos
- Department of Anatomy, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | |
Collapse
|
25
|
Fritz B, Parkar AP, Cerezal L, Storgaard M, Boesen M, Åström G, Fritz J. Sports Imaging of Team Handball Injuries. Semin Musculoskelet Radiol 2020; 24:227-245. [PMID: 32987422 DOI: 10.1055/s-0040-1710064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Team handball is a fast high-scoring indoor contact sport with > 20 million registered players who are organized in > 150 federations worldwide. The combination of complex and unique biomechanics of handball throwing, permitted body tackles and blocks, and illegal fouls contribute to team handball ranging among the four athletic sports that carry the highest risks of injury. The categories include a broad range of acute and overuse injuries that most commonly occur in the shoulder, knee, and ankle. In concert with sports medicine, physicians, surgeons, physical therapists, and radiologists consult in the care of handball players through the appropriate use and expert interpretations of radiography, ultrasonography, CT, and MRI studies to facilitate diagnosis, characterization, and healing of a broad spectrum of acute, complex, concomitant, chronic, and overuse injuries. This article is based on published data and the author team's cumulative experience in playing and caring for handball players in Denmark, Sweden, Norway, Germany, Switzerland, and Spain. The article reviews and illustrates the spectrum of common handball injuries and highlights the contributions of sports imaging for diagnosis and management.
Collapse
Affiliation(s)
- Benjamin Fritz
- Department of Radiology, Balgrist University Hospital, Zurich, and Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Anagha P Parkar
- Department of Radiology, Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Luis Cerezal
- Department of Radiology, Diagnostico Médico Cantabria, Santander, Spain
| | - Morten Storgaard
- Institute of Sports Medicine Copenhagen, Copenhagen Area, Denmark
| | - Mikael Boesen
- Department of Radiology Copenhagen university hospital, Bispebjerg and Frederiksberg, Copenhagen NV, Denmark.,Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Frederiksberg, Denmark
| | - Gunnar Åström
- Department of Immunology, Genetics and Pathology (Oncology) and department of Surgical Sciences (Radiology), Uppsala University, Uppsala, Sweden
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, New York University, New York, New York
| |
Collapse
|
26
|
Varada S, Moy MP, Wu F, Rasiej MJ, Jaramillo D, Wong TT. The prevalence of athletic pubalgia imaging findings on MRI in patients with femoroacetabular impingement. Skeletal Radiol 2020; 49:1249-1258. [PMID: 32144449 DOI: 10.1007/s00256-020-03405-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/22/2020] [Accepted: 02/25/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the prevalence of athletic pubalgia imaging findings on MRI in patients with femoroacetabular impingement and assess for correlative risk factors. MATERIALS AND METHODS A retrospective search identified 156 hips with femoroacetabular impingement and a control group of 113 without femoroacetabular impingement that had an MRI performed between January 1, 2015, and January 1, 2018. Two fellowship-trained musculoskeletal radiologists reviewed studies for the presence of acute osteitis pubis, chronic osteitis pubis, adductor tendinosis, and tendon tear; rectus abdominis tendinosis and tendon tear; and aponeurotic plate tear. Findings were correlated with various clinical and imaging risk factors. Univariate and multivariate statistical analyses were performed. RESULTS Imaging findings of adductor tendinosis (p = 0.02) and chronic osteitis pubis (p = 0.01) were more prevalent in FAI patients than controls. Univariate analyses in FAI patients showed that an alpha angle ≥ 60° had a higher prevalence of aponeurotic plate tears (p = 0.02) and adductor tendinosis (p = 0.049). Multivariate analyses showed that an alpha angle ≥ 60° had a higher prevalence of chronic osteitis pubis (OR = 2.27, p = 0.031), sports participation had a higher prevalence of adductor tendon tears (OR = 4.69, p = 0.013) and chronic osteitis pubis (OR = 2.61, p = 0.0058), and males had a higher prevalence of acute osteitis pubis (OR = 5.17, p = 0.032). CONCLUSION Sports participation, alpha angle ≥ 60°, and male sex predict a higher prevalence of athletic pubalgia imaging findings in patients with femoroacetabular impingement.
Collapse
Affiliation(s)
- Sowmya Varada
- Department of Radiology, Division of Musculoskeletal Radiology, NewYork-Presbyterian Hospital Columbia University Medical Center, 622 West 168th Street, MC-28, New York, NY, 10032, USA.
| | - Matthew P Moy
- Department of Radiology, Division of Musculoskeletal Radiology, NewYork-Presbyterian Hospital Columbia University Medical Center, 622 West 168th Street, MC-28, New York, NY, 10032, USA
| | - Fangbai Wu
- Department of Radiology, Division of Musculoskeletal Imaging, University of North Carolina at Chapel Hill, 101 Manning Dr. Chapel Hill, Chapell Hill, NC, 27514, USA
| | - Michael J Rasiej
- Department of Radiology, Division of Musculoskeletal Radiology, NewYork-Presbyterian Hospital Columbia University Medical Center, 622 West 168th Street, MC-28, New York, NY, 10032, USA
| | - Diego Jaramillo
- Department of Radiology, Division of Pediatric Radiology, NewYork-Presbyterian Hospital Columbia University Medical Center, 630 West 168th Street, MC-28, New York, NY, 10032, USA
| | - Tony T Wong
- Department of Radiology, Division of Musculoskeletal Radiology, NewYork-Presbyterian Hospital Columbia University Medical Center, 622 West 168th Street, MC-28, New York, NY, 10032, USA
| |
Collapse
|
27
|
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.
Collapse
|
28
|
Wilke J, Vleeming A, Wearing S. Overuse Injury: The Result of Pathologically Altered Myofascial Force Transmission? Exerc Sport Sci Rev 2020; 47:230-236. [PMID: 31290768 DOI: 10.1249/jes.0000000000000205] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Overuse injuries are suggested to result from repetitive microdamage eliciting pain in the affected tissue. Therapy commonly focuses on the area of symptom localization; however, such approach may oversimplify the true etiopathology. This review hypothesizes that the development of some sports-related soft tissue disorders, such as plantar fasciitis or lumbago, is promoted by pathologically altered force transmission from anatomically connected structures.
Collapse
Affiliation(s)
- Jan Wilke
- Department of Sports Medicine, Goethe University, Frankfurt, Germany
| | - Andry Vleeming
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Medical University Ghent, Ghent, Belgium
| | - Scott Wearing
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| |
Collapse
|
29
|
Delic JA, Ross AB, Blankenbaker DG, Woo K. Incidence and implications of fracture in core muscle injury. Skeletal Radiol 2019; 48:1991-1997. [PMID: 31172207 DOI: 10.1007/s00256-019-03249-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the pubic bone fracture incidence and associated injury patterns in patients with core muscle injury. MATERIALS AND METHODS Ninety-three consecutive patients with core muscle injury protocol MRI showing rectus abdominis-adductor longus aponeurotic plate injuries from June 2007 through August 2017 were independently analyzed in blinded fashion by two musculoskeletal radiologists for the presence or absence of pubic bone fracture. A variety of other osseous and soft tissue injury characteristics were recorded. Pain duration prior to MRI and return to play time were taken from the clinical record. Statistical analysis included fracture incidence as well as the association of fracture with other injury characteristics, duration of pain, and return to play time. RESULTS Eighty-seven men and six women with a mean age of 34.4 years (range, 16-66 years) were included in the study cohort. Overall fracture incidence was 18.3% (17/93) including 13 fatigue fractures of the pubic body and four elevated cortical fractures/fragments. After correction for multiple comparisons, no strong association was identified with osseous or soft tissue injury characteristics, pain duration, or return to play time. CONCLUSIONS Pubic fractures-particularly fatigue fractures-are a common co-existing injury in patients with a wide range of core muscle injury patterns. The presence of fracture did not have a strong correlation with injury patterns, pain duration, or return to play time but may have implications for patient management.
Collapse
Affiliation(s)
- Joseph A Delic
- University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA.
| | - Andrew B Ross
- University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Donna G Blankenbaker
- University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Kaitlin Woo
- University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| |
Collapse
|
30
|
|
31
|
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.
Collapse
|
32
|
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.
Collapse
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
| |
Collapse
|
33
|
Affiliation(s)
- Justin Neal Hopkins
- Department of Orthopaedic Surgery, University of California Davis, Sacramento, California
| | | | - Cassandra Alda Lee
- Department of Orthopaedic Surgery, University of California Davis, Sacramento, California
| |
Collapse
|
34
|
Via AG, Frizziero A, Finotti P, Oliva F, Randelli F, Maffulli N. Management of osteitis pubis in athletes: rehabilitation and return to training - a review of the most recent literature. Open Access J Sports Med 2019; 10:1-10. [PMID: 30613167 PMCID: PMC6307487 DOI: 10.2147/oajsm.s155077] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Osteitis pubis is a common cause of chronic groin pain, especially in athletes. Although a precise etiology is not defined, it seems to be related to muscular imbalance and pelvic instability. Diagnosis is based on detailed history, clinical evaluation, and imaging, which are crucial for a correct diagnosis and proper management. Many different therapeutic approaches have been proposed for osteitis pubis; conservative treatment represents the first-line approach and provides good results in most patients, especially if based on an individualized multimodal rehabilitative management. Different surgical options have been also described, but they should be reserved to recalcitrant cases. In this review, a critical analysis of the literature about athletic osteitis pubis is performed, especially focusing on its diagnostic and therapeutic management.
Collapse
Affiliation(s)
- Alessio Giai Via
- Department of Orthopaedic Surgery and Traumatology, Hip Surgery Center, IRCCS Policlinico San Donato, Milano, Italy
| | - Antonio Frizziero
- Department of Physical and Rehabilitation Medicine, University of Padova, Padova, Italy
| | - Paolo Finotti
- Department of Physical and Rehabilitation Medicine, University of Padova, Padova, Italy
| | - Francesco Oliva
- Department of Orthopaedics and Traumatology, Tor Vergata Hospital, University of Rome "Tor Vergata", Rome, Italy,
| | - Filippo Randelli
- Department of Orthopaedic Surgery and Traumatology, Hip Surgery Center, IRCCS Policlinico San Donato, Milano, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Salerno, Italy.,Centre for Sport and Exercise Medicine, Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, England
| |
Collapse
|
35
|
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.
Collapse
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.
| |
Collapse
|
36
|
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.
Collapse
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
| |
Collapse
|
37
|
Bou Antoun M, Reboul G, Ronot M, Crombe A, Poussange N, Pesquer L. Imaging of inguinal-related groin pain in athletes. Br J Radiol 2018; 91:20170856. [PMID: 29947268 DOI: 10.1259/bjr.20170856] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Inguinal canal-related groin pain is common in athletes and may involve numerous structures such as the conjoint tendon and the transversalis fascia. Ultrasound is the only dynamic tool that shows the passage of preperitoneal fat at the level of the Hesselbach triangle and allows excluding true inguinal hernias. Fascia transversalis bulging and inguinal ring dilatation may also be described. MRI assesses injuries of rectus abdominis and adductor longus enthesis and osteitis symphysis but its accuracy for the diagnosis of inguinal-related groin pain remains debated.
Collapse
Affiliation(s)
- Myriame Bou Antoun
- 1 Department of radiology, HEGP hospital, Assistance publique-hôpitaux de paris (AP-HP), University Paris Descartes , Paris , France
| | - Gilles Reboul
- 2 Hernia center, Clinique du sport, Bordeaux-Mérignac , Mérignac , France
| | - Maxime Ronot
- 3 Department of radiology, Beaujon hospital, Assistance publique- hôpitaux de Paris (AP-HP), University of Paris VII , Paris , France
| | - Amandine Crombe
- 4 MSK Imaging Department, Clinique du sport, Bordeaux-Mérignac , Merignac , France
| | - Nicolas Poussange
- 4 MSK Imaging Department, Clinique du sport, Bordeaux-Mérignac , Merignac , France
| | - Lionel Pesquer
- 4 MSK Imaging Department, Clinique du sport, Bordeaux-Mérignac , Merignac , France
| |
Collapse
|
38
|
Arlachov Y, Ibrahem Adam R. Acute hip pain: mimics of a femoral neck fracture. Clin Radiol 2018; 73:773-781. [PMID: 29903428 DOI: 10.1016/j.crad.2018.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 05/09/2018] [Indexed: 11/18/2022]
Abstract
Acute hip pain is a common presenting complaint among patients attending Emergency Departments particularly following a traumatic event. A proximal femoral fracture is the main consideration, which requires urgent confirmation and treatment; however, there are a number of conditions, which could mimic neck of femur fracture and the causes may not be directly related to the hip, so systematic and careful observation of pelvic MRI could shed light on the true culprit of acute hip pain.
Collapse
Affiliation(s)
- Y Arlachov
- Department of Radiology, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NH5 1PB, UK.
| | - R Ibrahem Adam
- Department of Radiology, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NH5 1PB, UK
| |
Collapse
|
39
|
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.
Collapse
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
| |
Collapse
|
40
|
Hopp S, Ojodu I, Jain A, Fritz T, Pohlemann T, Kelm J. Novel pathomorphologic classification of capsulo-articular lesions of the pubic symphysis in athletes to predict treatment and outcome. Arch Orthop Trauma Surg 2018; 138:687-697. [PMID: 29417208 DOI: 10.1007/s00402-018-2893-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Radiographic abnormalities of the symphysis as well as the formation of accessory clefts, indicating injury at the rectus-adductor aponeurosis, reportedly relate to longstanding groin pain in athletes. However, yet, no systematic classification for clinical and scientific purposes exists. We aimed to (1) create a radiographic classification based on symphysography; (2) test intra- and interobserver reliability; (3) characterise clinical significance of the morphologic patterns by evaluating success of injection therapy. PATIENTS AND METHODS We retrospectively reviewed symphysography, AP radiographs, and MRI of the pelvis from 70 consecutive competitive athletes, with chronic groin pain. Symphysographs were evaluated for intra- and interobserver variance using cohen's kappa statistics. Morphologic studies of the different contrast distribution patterns and their clinical and radiological correlation with symptom relief were investigated. All patients were followed up to evaluate immediate and long-term response to the initial therapeutic injection with steroid. RESULTS Four reproducible symphysographic patterns were identified: type 0, no changes; type 1, symphyseal disk degeneration; types 2a with unilateral clefts, bilateral clefts (2b), suprapubic clefts (2c); and type 3, with expanded or multidirectional clefts. Analysis revealed excellent intra (0.94)-and interobserver (0.90) reliability. Our findings showed that 78.6% of our patients had significant short-term improvement enabling early resumption of physiotherapy, only in types 1 and 2 (p = 0.001), while type 0 and 3 did not respond. At follow-up, only 21.8% had permanent pain relief. Regarding the detection of pathologic clefts with symphysography, sensitivity (88%) and specifity (77%) were superior to that of MRI. CONCLUSIONS A reproducible symphysography-based classification of distinct morphologic patterns is proposed. It serves as a predictive tool for response to injection therapy in a select group of pathologic lesions. Complete recovery after injection can only be expected in a lesser percentage, as this might indicate surgical treatment for long-term non-responders.
Collapse
Affiliation(s)
- Sascha Hopp
- Lutrina Clinic Kaiserslautern, Centre for Knee Surgery, Orthopaedics and Sports Traumatology, Groin Pain and Core Muscle Injury Centre, Karl-Marx-Strasse 33, 67655, Kaiserslautern, Germany. .,Department of Trauma, Hand and Reconstructive Surgery, University of Saarland, Homburg, Saar, Germany.
| | - Ishaq Ojodu
- Department of Trauma, Hand and Reconstructive Surgery, University of Saarland, Homburg, Saar, Germany.,Ondo State Trauma Centre, Ondo, Nigeria
| | - Atul Jain
- Department of Trauma, Hand and Reconstructive Surgery, University of Saarland, Homburg, Saar, Germany.,Department of Orthopaedics, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi, India
| | - Tobias Fritz
- Department of Trauma, Hand and Reconstructive Surgery, University of Saarland, Homburg, Saar, Germany
| | - Tim Pohlemann
- Department of Trauma, Hand and Reconstructive Surgery, University of Saarland, Homburg, Saar, Germany
| | - Jens Kelm
- Chirurgisch-Orthopädisches Zentrum, Illingen, Germany
| |
Collapse
|
41
|
Meyer NB, Jacobson JA, Kalia V, Kim SM. Musculoskeletal ultrasound: athletic injuries of the lower extremity. Ultrasonography 2018; 37:175-189. [PMID: 29794963 PMCID: PMC6044222 DOI: 10.14366/usg.18013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/14/2018] [Indexed: 12/23/2022] Open
Abstract
Athletic injuries of the lower extremities are commonly encountered in clinical practice. While some pathology can be diagnosed on physical exam, others are a clinical dilemma with nonspecific symptomatology. In these situations, ultrasound imaging can be utilized as an exceptional diagnostic tool, offering unique advantages over other imaging modalities. This article will review the imaging characteristics of commonly encountered athletic injuries of the lower extremity.
Collapse
Affiliation(s)
- Nathaniel B Meyer
- Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Jon A Jacobson
- Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Vivek Kalia
- Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Sung Moon Kim
- Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
| |
Collapse
|
42
|
|
43
|
Abstract
PURPOSE OF REVIEW To discuss the clinical significance of the most common hip and groin injuries in baseball players, as well as an algorithmic approach to diagnosis and treatment of these injuries. RECENT FINDINGS (a) Limitations in throwing velocity, pitch control, and bat swing speed may be secondary to decreased mobility and strength within the proximal kinetic chain, which must harness power from the lower extremities and core. (b) Approximately 5.5% of all baseball injuries per year involve the hip/groin and may lead to a significant amount of time spent on the disabled list. Injuries involving the hip and groin are relatively common in baseball players. Our knowledge of the mechanics of overhead throwing continues to evolve, as does our understanding of the contribution of power from the lower extremities and core. It is paramount that the team physician be able to accurately diagnose and treat injuries involving the hip/groin, as they may lead to significant disability and inability to return to elite levels of play. This review focuses on hip- and groin-related injuries in the baseball player, including femoroacetabular impingement, core muscle injury, and osteitis pubis.
Collapse
Affiliation(s)
- Ryan A Mlynarek
- Sports Medicine and Hip Preservation, Hospital for Special Surgery, New York, NY, USA. .,Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 E. 70th Street, New York, NY, 10021, USA.
| | - Struan H Coleman
- Sports Medicine and Hip Preservation, Hospital for Special Surgery, New York, NY, USA
| |
Collapse
|
44
|
Matalon SA, Askari R, Gates JD, Patel K, Sodickson AD, Khurana B. Don't Forget the Abdominal Wall: Imaging Spectrum of Abdominal Wall Injuries after Nonpenetrating Trauma. Radiographics 2017; 37:1218-1235. [PMID: 28696855 DOI: 10.1148/rg.2017160098] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Abdominal wall injuries occur in nearly one of 10 patients coming to the emergency department after nonpenetrating trauma. Injuries range from minor, such as abdominal wall contusion, to severe, such as abdominal wall rupture with evisceration of abdominal contents. Examples of specific injuries that can be detected at cross-sectional imaging include abdominal muscle strain, tear, or hematoma, including rectus sheath hematoma (RSH); traumatic abdominal wall hernia (TAWH); and Morel-Lavallée lesion (MLL) (closed degloving injury). These injuries are often overlooked clinically because of (a) a lack of findings at physical examination or (b) distraction by more-severe associated injuries. However, these injuries are important to detect because they are highly associated with potentially grave visceral and vascular injuries, such as aortic injury, and because their detection can lead to the diagnosis of these more clinically important grave traumatic injuries. Failure to make a timely diagnosis can result in delayed complications, such as bowel hernia with potential for obstruction or strangulation, or misdiagnosis of an abdominal wall neoplasm. Groin injuries, such as athletic pubalgia, and inferior costochondral injuries should also be considered in patients with abdominal pain after nonpenetrating trauma, because these conditions may manifest with referred abdominal pain and are often included within the field of view at cross-sectional abdominal imaging. Radiologists must recognize and report acute abdominal wall injuries and their associated intra-abdominal pathologic conditions to allow appropriate and timely treatment. © RSNA, 2017.
Collapse
Affiliation(s)
- Shanna A Matalon
- From the Departments of Radiology (S.A.M., A.D.S., B.K.) and Trauma, Burns, and Critical Care (R.A., J.D.G.), Brigham and Women's Hospital, 75 Francis St, Mellins Library, Boston, MA 02115; and Shields Radiology, Brockton, Mass (K.P.)
| | - Reza Askari
- From the Departments of Radiology (S.A.M., A.D.S., B.K.) and Trauma, Burns, and Critical Care (R.A., J.D.G.), Brigham and Women's Hospital, 75 Francis St, Mellins Library, Boston, MA 02115; and Shields Radiology, Brockton, Mass (K.P.)
| | - Jonathan D Gates
- From the Departments of Radiology (S.A.M., A.D.S., B.K.) and Trauma, Burns, and Critical Care (R.A., J.D.G.), Brigham and Women's Hospital, 75 Francis St, Mellins Library, Boston, MA 02115; and Shields Radiology, Brockton, Mass (K.P.)
| | - Ketan Patel
- From the Departments of Radiology (S.A.M., A.D.S., B.K.) and Trauma, Burns, and Critical Care (R.A., J.D.G.), Brigham and Women's Hospital, 75 Francis St, Mellins Library, Boston, MA 02115; and Shields Radiology, Brockton, Mass (K.P.)
| | - Aaron D Sodickson
- From the Departments of Radiology (S.A.M., A.D.S., B.K.) and Trauma, Burns, and Critical Care (R.A., J.D.G.), Brigham and Women's Hospital, 75 Francis St, Mellins Library, Boston, MA 02115; and Shields Radiology, Brockton, Mass (K.P.)
| | - Bharti Khurana
- From the Departments of Radiology (S.A.M., A.D.S., B.K.) and Trauma, Burns, and Critical Care (R.A., J.D.G.), Brigham and Women's Hospital, 75 Francis St, Mellins Library, Boston, MA 02115; and Shields Radiology, Brockton, Mass (K.P.)
| |
Collapse
|
45
|
Sports-Related Groin Pain Secondary to Symphysis Pubis Disorders: Correlation Between MRI Findings and Outcome After Fluoroscopy-Guided Injection of Steroid and Local Anesthetic. AJR Am J Roentgenol 2017; 209:380-388. [DOI: 10.2214/ajr.16.17578] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
46
|
Vasileff WK, Nekhline M, Kolowich PA, Talpos GB, Eyler WR, van Holsbeeck M. Inguinal Hernia in Athletes: Role of Dynamic Ultrasound. Sports Health 2017; 9:414-421. [PMID: 28732177 PMCID: PMC5582701 DOI: 10.1177/1941738117717009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Inguinal hernia is a commonly encountered cause of pain in athletes. Because of the anatomic complexity, lack of standard imaging, and the dynamic condition, there is no unified opinion explaining its underlying pathology. Hypothesis: Athletes with persistent groin pain would have a high prevalence of inguinal hernia with dynamic ultrasound, and herniorrhaphy would successfully return athletes to activity. Study Design: Case-control study. Level of Evidence: Level 3. Methods: Forty-seven amateur and professional athletes with sports-related groin pain who underwent ultrasound were selected based on history and examination. Patients with prior groin surgery or hip pathology were excluded. Clinical and surgical documentation were correlated with imaging. The study group was compared with 41 age-matched asymptomatic athletes. Results: Ultrasound was positive for hernia with movement of bowel, bladder, or omental tissue anterior to the inferior epigastric vessels during Valsalva maneuver. The 47-patient symptomatic study group included 41 patients with direct inguinal hernias, 1 with indirect inguinal hernia, and 5 with negative ultrasound. Of 42 patients with hernia, 39 significantly improved with herniorrhaphy, 2 failed to improve after surgery and were diagnosed with adductor longus tears, and 1 improved with physical therapy. Five patients with negative ultrasound underwent magnetic resonance imaging and were diagnosed with hip labral tear or osteitis pubis. The 41-patient asymptomatic control group included 3 patients with direct inguinal hernias, 2 with indirect inguinal hernias, and 3 with femoral hernias. Conclusion: Inguinal hernias are a major component of groin pain in athletes. Prevalence of direct inguinal hernia in symptomatic athletes was greater than that for controls (P < 0.001). Surgery was successful in returning these athletes to sport: 39 of 42 (93%) athletes with groin pain and inguinal hernia became asymptomatic. Clinical Relevance: Persistent groin pain in the athlete may relate to inguinal hernia, which can be diagnosed with dynamic ultrasound imaging. Herniorrhaphy is successful at returning athletes to sports activity.
Collapse
Affiliation(s)
| | | | | | - Gary B Talpos
- Department of Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Willam R Eyler
- Department of Radiology, Henry Ford Hospital, Detroit, Michigan
| | | |
Collapse
|
47
|
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.
Collapse
|
48
|
Alapati S, Wadhwa V, Komarraju A, Guidry C, Pandey T. Magnetic Resonance Imaging of Nonneoplastic Musculoskeletal Pathologies in the Pelvis. Semin Ultrasound CT MR 2017; 38:291-308. [PMID: 28705373 DOI: 10.1053/j.sult.2016.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Musculoskeletal pathologies in the pelvis encompass a wide variety of lesions including femoroacetabular impingement, athletic pubalgia, ischiofemoral impingement, and apophyseal avulsion injuries. Magnetic resonance imaging is the noninvasive imaging modality of choice for the diagnosis and management of these lesions. In this article, the authors discuss the nonneoplastic musculoskeletal lesions in the pelvis, with illustrations and relevant case examples.
Collapse
Affiliation(s)
- Sindhura Alapati
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR.
| | - Vibhor Wadhwa
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Aparna Komarraju
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Carey Guidry
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Tarun Pandey
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
| |
Collapse
|
49
|
|
50
|
Agten CA, Sutter R, Buck FM, Pfirrmann CWA. Hip Imaging in Athletes: Sports Imaging Series. Radiology 2017; 280:351-69. [PMID: 27429142 DOI: 10.1148/radiol.2016151348] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Hip or groin pain in athletes is common and clinical presentation is often nonspecific. Imaging is a very important diagnostic step in the work-up of athletes with hip pain. This review article provides an overview on hip biomechanics and discusses strategies for hip imaging modalities such as radiography, ultrasonography, computed tomography, and magnetic resonance (MR) imaging (MR arthrography and traction MR arthrography). The authors explain current concepts of femoroacetabular impingement and the problem of high prevalence of cam- and pincer-type morphology in asymptomatic persons. With the main focus on MR imaging, the authors present abnormalities of the hip joint and the surrounding soft tissues that can occur in athletes: intraarticular and extraarticular hip impingement syndromes, labral and cartilage disease, microinstability of the hip, myotendinous injuries, and athletic pubalgia. (©) RSNA, 2016.
Collapse
Affiliation(s)
- Christoph A Agten
- From the Department of Radiology, Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland; and Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Reto Sutter
- From the Department of Radiology, Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland; and Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Florian M Buck
- From the Department of Radiology, Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland; and Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Christian W A Pfirrmann
- From the Department of Radiology, Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland; and Faculty of Medicine, University of Zurich, Zurich, Switzerland
| |
Collapse
|