Imaging of sports-related hip and groin injuries

Imaging of common hip pathologies in runners

Running is an increasingly popular sport and form of exercise. Because of the importance of the hip in the biomechanics involved with running, forming the primary connection between the axial and appendicular skeleton of the lower extremities, accurate diagnosis and reporting of hip pathology are vital for appropriate management. This review provides an overview of the most common hip pathologies and injuries encountered in runners. Radiologic studies, primarily conventional radiography and magnetic resonance imaging (MRI) provide useful diagnostic information and should be used in combination with clinical findings to help guide therapeutic management.

Cross-sectional Study of the Hip Joint Condition in Young Baseball Players

Objective

The hip joint is a crucial part of the kinetic chain for throwing baseball pitches. Nevertheless, few reports have described assessments of the functional development of the hip joint in young baseball players.

Methods

We examined 315 young baseball players, 7-14 years old, all of whom had completed a self-administered questionnaire including items related to the dominant side and throwing-related hip joint pain sustained during the previous year. We measured the hip ranges of motion (ROMs: external and internal rotation and flexion) and hip muscle strengths (external and internal rotation) on the dominant and non-dominant sides. The differences of hip ROMs and muscle strengths between the dominant and non-dominant sides and between age groups were investigated. Correlations were calculated between the players ages and hip ROMs and muscle strengths.

Results

No baseball player reported hip pain. The hip external rotation on the dominant side was smaller than that on the non-dominant side, whereas the hip internal rotation on the dominant side was greater than that on the non-dominant side. However, no significant difference was found between the dominant and non-dominant sides in terms of the hip muscle strength. Significant positive associations were found between the player's age and hip muscle strengths, whereas significant negative associations were found between the age and hip ROMs.

Conclusions

Our data concerning the relationship between age and hip joint development could be useful for supporting strategies for the prevention and rehabilitation of throwing injuries; however, hip injuries might be rare among young baseball players.

Lower limb muscle injuries: The good, the bad and the ugly

Injuries to the lower limb muscles are a common cause of absence from training and competition in athletes. The different muscular groups of the thigh and leg are involved in various activities with kicking and sprinting being responsible for the largest number of injuries. The muscle acts on bone through the tendon and the fascia. The failure of one or more of these structures results in various degrees of loss of function of the muscle(s) involved. Usually, the point of weakness is the interface between different structures with different elastic properties (myofascial, myotendinous, avulsion). Diagnostic imaging is best performed by MRI that provides valuable information about the severity of the injury and its anatomical extent. In this article, we will review the MRI features of muscle injuries which can be used to guide return to play. We will emphasize the clinical implications of the MRI findings by dividing the muscle injuries into three categories "The Good, The Bad and The Ugly" to help the clinician in the planning of the most appropriate rehabilitation strategy.

MRI in patients with chronic pubalgia: Is precise useful information provided to the surgeon? A case-control study

BACKGROUND

Recent studies described that MRI is a good examination to assess damage in chronic athletic pubalgia (AP). However, to our knowledge, no studies focus on systematic correlation of precise tendon or parietal lesion in MRI with surgery and histological assessment. Therefore, we performed a case-control study to determine if MRI can precisely assess Adductor longus (AL) tendinopathy and parietal lesion, compared with surgery and histology.

HYPOTHESIS

MRI can determine if AP comes from pubis symphysis, musculotendinous or inguinal orifice structures.

MATERIALS/METHODS

Eighteen consecutive patients were enrolled from November 2011 to April 2013 for chronic AP. To constitute a control group, we also enrolled 18 asymptomatic men. All MRI were reviewed in consensus by 2 skeletal radiologists for pubic symphysis, musculotendinous, abdominal wall assessment and compared to surgery and histology findings.

RESULTS

Regarding pubis symphysis, we found 4 symmetric bone marrow oedema (14%), 2 secondary cleft (7%) and 2 superior ligaments lesions (7%). For AL tendon, we mainly found 13 asymmetric bone marrow oedema (46%), 15 hyperaemia (54%). Regarding abdominal wall, the deep inguinal orifice size in the group of symptomatic athletes and the control group was respectively 27.3±6.4mm and 23.8±6.3mm. The correlation between MRI and surgery/histology was low: 20% for the AL tendon and 9% for the abdominal wall. If we chose the criteria "affected versus unaffected", this correlation became higher: 100% for AL tendon and 73% for the abdominal wall.

CONCLUSION

MRI chronic athletic pubalgia concerns preferentially AL tendinopathy and deep inguinal canal dehiscence with high correlation to surgery/histology when only considering the item "affected versus unaffected" despite low correlation when we try to precisely grade these lesions.

LEVEL OF EVIDENCE

III: case-control study.

The Role of Femoroacetabular Impingement in Core Muscle Injury/Athletic Pubalgia: Diagnosis and Management

Chronic groin pain in athletes represents a major diagnostic and therapeutic challenge in sports medicine. Two recognized causes of inguinal pain in the young adult athlete are core muscle injury/athletic pubalgia (CMI/AP) and femoroacetabular impingement (FAI). CMI/AP and FAI were previously considered to be two distinct entities; however, recent studies have suggested both entities to frequently coincide in the athlete with groin pain. This article briefly discusses the role of FAI in CMI/AP and the diagnosis and management of this complex disease.

Regional interdependence of the hip and lumbo-pelvic region in divison ii collegiate level baseball pitchers: a preliminary study

BACKGROUND

Pitchers may be at greater risk of injury in comparison to other overhead throwing athletes due to the repetition of the pitching motion. It has been reported that approximately 30% of all baseball injuries occur in the lower body. This may be related to limited hip mobility, which can compromise pitching biomechanics while placing excessive stress on the trunk and upper quarter. Hip motion and strength measurements have been reported in professional baseball pitchers but have not been reported in collegiate pitchers.

PURPOSE

The purpose of this study was to report preliminary findings for passive hip motion and isometric hip muscle strength in collegiate pitchers and compare them to previously published values for professional level pitchers.

STUDY DESIGN

Cross sectional study.

METHODS

Twenty-nine collegiate baseball pitchers (age = 20.0 + 1.4 years, height = 1.88 + 0.06 m; weight = 89.3 + 10.7 kg; body mass index = 25.3 + 2.5 kg/m2) were recruited. Subjects were assessed for hip internal rotation (IR) and external rotation (ER) passive motion, hip anteversion or retroversion, gluteus maximus, gluteus medius, hip internal rotator, hip external rotator strength, and lumbo-pelvic control with the prone active hip rotation test as described by Sahrmann. Statistical analysis included calculation of subject demographics (means and SD) and use of a two-tailed t-test (p >0.05).

RESULTS

Fifty-two percent of the right-handed and 50% of the left-handed pitchers demonstrated poor lumbo-pelvic motor control with an inability to stabilize during active hip IR and ER even though isolated strength deficits were not detected at a significant level. There were no significant differences in hip passive motion or gluteus medius strength between right and left-handed pitchers. Differences did exist between collegiate data and previously published values for professional pitchers for IR motion measured in prone and gluteus maximus strength. Hip retroversion was present in 55% of the pitchers primarily in both limbs with four of the pitchers presenting with retroversion singularly in either the stride or trail limb where the ER rotation motion was greater than the IR.

CONCLUSION

Assessing mobility and muscle strength of the lower quarter in isolation can be misleading and may not be adequate to ensure the potential for optimal pitching performance. These findings suggest that lumbo-pelvic control in relation to the lower extremities should be assessed as one functional unit. This is the first study to explore hip motion, strength, and lumbo-pelvic control during active hip rotation in collegiate baseball pitchers.

EVIDENCE LEVEL

2.

Middle and lower trapezius strengthening for the management of lateral epicondylalgia: a case report

STUDY DESIGN

Case report.

BACKGROUND

Addressing weakness of the shoulder region, especially the rotator cuff and scapular musculature, is often suggested clinically for the treatment of individuals with lateral epicondylalgia. However, to our knowledge, the clinical effectiveness of this approach has not been established.

CASE DESCRIPTION

The patient was a 54-year-old woman with a 5-month history of right lateral elbow pain, whose symptoms were reproduced with clinical tests typically used to diagnose lateral elbow tendinopathy. The patient also demonstrated weakness in her middle and lower trapezius muscles, and the medial border of her scapula, measured with a tape measure, was 11 cm lateral from the spinous processes of the thoracic spine with the patient standing in relaxed stance. Based on improved grip strength and reduced associated elbow pain when tested with the scapula manually corrected in a more adducted position, treatment focused solely on strengthening of the middle and lower trapezius muscles over a 10-week period.

OUTCOMES

Following the intervention, the patient presented with improved scapular position, with the medial border of the scapula being 9 cm lateral to the midthoracic spine. The patient's middle and lower trapezius strength improved from 3+/5 and 4-/5, respectively, to 5/5, and her grip strength from 26.1 to 42.2 kg. The patient's scores on the Disabilities of the Arm, Shoulder and Hand questionnaire also improved from 44.2 at the initial evaluation to 0 at the completion of therapy, with the patient being able to perform all of her daily activities in a pain-free manner.

DISCUSSION

The results of this case report suggest that assessment and treatment of scapular musculature warrant consideration in the management of individuals with lateral epicondylalgia.

LEVEL OF EVIDENCE

Therapy, level 4.

Imaging assessment of groin pain

Groin pain is a common condition in athletes, especially those who play certain sports, for instance soccer, ice hockey, fencing which request rapid acceleration and frequent changes of movement. This condition represents a diagnostic difficulty for the radiologist due to either the anatomical pubic region complexity than the many causes that can be a source of pain, because the groin pain can be determined by conditions affecting the bony structures, cartilage and muscle tendons that are part of the proper pubis but also from those involving the hip. The approach to the groin through diagnostic imaging is multidisciplinary: The study of the patient is performed by traditional radiographs, ultrasound examination, magnetic resonance imaging or computed tomography, based on clinical suspicion, and each of these methods provides different results depending on the disease in question. The purpose of this article is to examine what are the optimal imaging techniques to investigate the various diseases affecting the patient with groin pain.