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Salman R, Albar A, Kan JH. MR imaging spectrum of adolescent pubic symphyseal injuries/athletic pubalgia. Pediatr Radiol 2024; 54:1270-1280. [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] [MESH Headings] [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.
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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
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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.
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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
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Pushpa NB, Patra A, Ravi KS, Viveka S, Pushpalatha K, Smitha MC. Reappraisal of the anatomical diversities of the pyramidalis muscle with their potential clinical applicability: cadaveric analysis. Surg Radiol Anat 2024; 46:203-210. [PMID: 38182780 DOI: 10.1007/s00276-023-03278-6] [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: 04/21/2023] [Accepted: 11/30/2023] [Indexed: 01/07/2024]
Abstract
INTRODUCTION The present study examined the morphology and morphometric parameters of the pyramidalis muscle (PM) in detail with their potential applicability in making midline infra-umbilical incisions and biomechanics of the linea alba. METHODS PM was examined in 51 formalin-fixed cadavers (36 males and 15 females), and based on the mode of insertion or the level of apex, the formation or shape of the muscle was classified into nine types (Mori's classification). RESULTS Bilateral PM was more prevalent (39.21%) than unilateral (1.96%) (p = 0.001). All the cases showed side symmetry except one. Mori's type 7 (right PM is higher apex and the left PM with elongated origin) was the most common form. The mean length of PM in males and females was 4.51 ± 0.14 and 3.33 ± 0.12 cm on the right and 4.51 ± 0.11 and 3.26 ± 0.16 cm on the left side. The mean width of right-sided PMs in males and females was 1.90 ± 0.17 and 1.58 ± 0.13 cm and left-sided 1.88 ± 0.14 and 1.55 ± 0.38 cm. The mean of pyramidalis-pubo-umbilical index (PPI) in males and females was 32.82 ± 1.65 and 27.50 ± 1.08, respectively. The mean insertion angle was 24.56 ± 3.07 on right side and 23 ± 2.03 on the left side (p = 0.03). Male predominance existed on right- and left-sided PM length (p < 0.001 and p < 0.001), width (p = 0.001) and PPI (p = 0.001). The strong positive correlation (r = 0.83) between length and width indicates a symmetrical muscle augmentation in the two dimensions. CONCLUSION PM is an inconsistent anatomical structure with persistent morphology. The level and angle of insertion into the linea are crucial in the biomechanics of linea alba. PPI, determining the termination level would be useful to surgeons making midline infra-umbilical incisions.
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Affiliation(s)
- N B Pushpa
- JSS Medical College, JAASHER, Mysore, India
| | - Apurba Patra
- All India Institute of Medical Sciences, Bathinda, India.
| | - K S Ravi
- All India Institute of Medical Sciences, Gorakhpur, India
| | - S Viveka
- Healiosomed Academy, Bangalore, India
| | | | - M C Smitha
- JSS Medical College, JAASHER, Mysore, India
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Bordalo M, Serner A, Yamashiro E, Al-Musa E, Djadoun MA, Al-Khelaifi K, Schumacher YO, Al-Kuwari AJ, Massey A, D'Hooghe P, Cardinale M. Imaging-detected sports injuries and imaging-guided interventions in athletes during the 2022 FIFA football (soccer) World Cup. Skeletal Radiol 2023:10.1007/s00256-023-04451-z. [PMID: 37715819 DOI: 10.1007/s00256-023-04451-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: 08/02/2023] [Revised: 09/01/2023] [Accepted: 09/03/2023] [Indexed: 09/18/2023]
Abstract
OBJECTIVE To describe imaging-detected musculoskeletal injuries and image-guided interventional procedures during the 2022 FIFA football (soccer) World Cup. MATERIALS AND METHODS Retrospective analysis of all radiologic examinations performed in a central medical facility for athletes was performed by two board certified musculoskeletal radiologists. Data on muscle, tendon, ligament, cartilage, and bone injuries were collected according to imaging modality and body part. RESULTS A total of 143 radiology examinations in 94 athletes were evaluated at the central medical facility. Magnetic resonance imaging (MRI) was the most utilized modality (67%), followed by radiography (12%), ultrasonography (9%), and computed tomography (4%). Image-guided interventions corresponded to 8% of all radiological examinations. There were 112 injuries described, affecting muscles and tendons (42%), ligaments (25%), cartilage (21%), and bone (12%). Most injured body parts were thigh (27%), foot and ankle (23%), knee (23%), and hip/groin (8%). Most injured players were within the age range of 24-35 years old (71%). CONCLUSION Imaging was utilized in 11% of players who participated in the 2022 FIFA World Cup in Qatar. MRI was the most utilized modality, and acute muscle tears were the most diagnosed type of injury. Diagnostic imaging played an important role in diagnosing sports-related injuries during the 2022 FIFA World Cup.
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Affiliation(s)
- Marcelo Bordalo
- Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar.
| | - Andreas Serner
- Fédération Internationale de Football Association (FIFA), Zurich, Switzerland
| | | | - Emad Al-Musa
- Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
| | | | | | | | | | - Andrew Massey
- Fédération Internationale de Football Association (FIFA), Zurich, Switzerland
| | - Pieter D'Hooghe
- Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
| | - Marco Cardinale
- Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
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So CC, Niakan LS, Garza-Gongora RD. Imaging of the Pubic Symphysis: Anatomy and Pathologic Conditions. Radiographics 2023; 43:e220058. [PMID: 36656759 DOI: 10.1148/rg.220058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Connie C So
- From the Musculoskeletal Section, Department of Radiology, Baylor Scott & White Medical Center, 2401 S 31st St, Temple, TX 76508
| | - Lillian S Niakan
- From the Musculoskeletal Section, Department of Radiology, Baylor Scott & White Medical Center, 2401 S 31st St, Temple, TX 76508
| | - Ricardo D Garza-Gongora
- From the Musculoskeletal Section, Department of Radiology, Baylor Scott & White Medical Center, 2401 S 31st St, Temple, TX 76508
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Weber MA. [Groin pain in athletes-sportsmen's groin]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:268-274. [PMID: 36715718 DOI: 10.1007/s00117-023-01117-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 01/31/2023]
Abstract
CLINICAL/METHODICAL ISSUE Groin pain in athletes can have various causes. Radiologically, osteitis pubis and clefts with affection of the interpubic disc as well as muscle and tendon tears near the pubic bone can be clearly identified. STANDARD RADIOLOGICAL METHODS Magnetic resonance imaging (MRI) is the imaging modality of choice, as well as single-leg stand imaging (flamingo view radiographs), and where appropriate symphysography. METHODICAL INNOVATIONS Optimized MRI sequence protocol with oblique (axial oblique) slices parallel to the linea arcuata of the iliac bone is recommended. High-resolution MRI sequences and symphysography can detect superior and secondary cleft formation. Instabilities of the pubic symphysis can be diagnosed using flamingo view radiographs. PERFORMANCE The MRI findings of osteitis pubis and clinical symptoms correlate. The presence of parasymphyseal bone marrow edema is the earliest morphological sign of acute osteitis pubis on MR imaging. Edema in the periosteal tissue and isolated muscle lesions next to the symphysis are generally associated with more severe clinical symptoms. ACHIEVEMENTS AND PRACTICAL RECOMMENDATIONS Close communication between radiologists and the referring physicians is indispensable when planning an adequate imaging protocol, and precise knowledge of the clinical symptoms in the case of clinical suspicion of osteitis pubis allows for a reliable diagnosis and provides important prognostic information.
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Affiliation(s)
- Marc-André Weber
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland.
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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.
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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
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Groin Pain in Athletes. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00364-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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9
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Efrima B, Amar E, Ovadia JE, Levy O, Ben Yehuda O, Rath E. Magnetic Resonance Imaging Is Not Reliable in Classifying Anterior Inferior Iliac Spine Morphology Compared to 3-Dimensional Computerized Tomography. Arthroscopy 2022; 38:793-798. [PMID: 34246520 DOI: 10.1016/j.arthro.2021.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/30/2021] [Accepted: 06/06/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study is to determine the reliability of standard magnetic resonance imaging (MRI) evaluation of AIIS morphology compared with three-dimensional (3D) computerized tomography (CT) (reference standard). METHODS Sixty hips in 30 patients met the inclusion criteria. The images were reviewed and classified by two fellowship-trained orthopedic surgeons. A second imaging viewing session was conducted in the same manner for validation of AIIS evaluation. The agreement and accuracy indices between the two raters were calculated for each imaging modality (inter-rater agreement) as well the agreement across the imaging modality for each rater (intermethod agreement). RESULTS The inter-rater agreement for the morphological evaluation of the AIIS for the first session according to 3D CT was .553 (P < .05) and by means of MRI was .0163 (P < .05). The inter-rater agreement for the second session by means of 3D CT was .449 (P < .05) and according to MRI was 0 (P < .05). The inter-method agreement for rater 1 for the first session was .04 (P < 0.05), while the agreement for rater 2 was .016 (P < .05). The intermethod agreement for rater 1 on the second session was .35 (P < 0.05), while that of rater 2 was .297(P < .05). The overall accuracy of MRI compared to 3D CT for rater 1 for the first session was .531, .490, and .959 for types I, II, III respectively and .551, .531, and .980 for the second session for types I, II, and III respectively. The overall accuracy of MRI compared to 3D CT for rater 2 for the first session was .551, .469, and .918 for types I, II, III respectively and .633, .592, and .918 for the second session for types I, II, and III, respectively. CONCLUSION MRI evaluations and subsequent classifications of AIIS morphology demonstrated a poor to slight correlation compared with that of the reference standard of 3D CT. LEVEL OF EVIDENCE Level II, retrospective diagnostic study.
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Affiliation(s)
- Ben Efrima
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Amar
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joshua Ezekiel Ovadia
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ofer Levy
- Reading Shoulder Unit, Royal Berkshire Hospital, Reading, Unite Kingdom
| | - Omer Ben Yehuda
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Rath
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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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.
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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
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Eberbach H, Fürst-Meroth D, Kloos F, Leible M, Bohsung V, Bode L, Wenning M, Hagen S, Bode G. Long-standing pubic-related groin pain in professional academy soccer players: a prospective cohort study on possible risk factors, rehabilitation and return to play. BMC Musculoskelet Disord 2021; 22:958. [PMID: 34789227 PMCID: PMC8600924 DOI: 10.1186/s12891-021-04837-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 11/01/2021] [Indexed: 11/29/2022] Open
Abstract
Background Despite being a common overuse entity in youth soccer, scientific data on risk factors, rehabilitation and return to play for long-standing pubic-related groin pain is still rare. The current prospective cohort study aims to evaluate potential risk-factors, propose a criteria-based conservative rehabilitation protocol and assess return-to-play outcomes among professional youth soccer players suffering from long-standing pubic-related groin pain. Methods Male soccer players with long-standing (> 6 weeks) pubic-related groin pain from a professional soccer club’s youth academy were analyzed for possible risk factors such as age, team (U12 - U23), younger/older age group within the team, position and preinjury Functional movement score. All injured players received a conservative, standardized, supervised, criteria-based, 6-level rehabilitation program. Outcome measures included time to return to play, recurrent groin pain in the follow-up period and clinical results at final follow-up two years after their return to play. Results A total of 14 out of 189 players developed long-standing pubic-related groin pain in the 2017/2018 season (incidence 7.4%). The average age of the players at the time of the injury was 16.1 ± 1.9 years. Risk factor analysis revealed a significant influence of the age group within the team (p = .007). Only players in the younger age group were affected by long-standing pubic-related groin pain, mainly in the first part of the season. Injured players successfully returned to play after an average period of 135.3 ± 83.9 days. Only one player experienced a recurrence of nonspecific symptoms (7.1%) within the follow-up period. The outcome at the 24-month follow-up was excellent for all 14 players. Conclusions Long-standing pubic-related groin pain is an overuse entity with a markedly high prevalence in youth soccer players, resulting in a relevant loss of time in training and match play. In particular, the youngest players in each team are at an elevated risk. Applying a criteria-based rehabilitation protocol resulted in an excellent return-to-play rate, with a very low probability of recurrence. Trial registration The trial was retrospectively registered under DRKS00016510 in the German Clinical Trials Register on 19.04.2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04837-x.
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Affiliation(s)
- Helge Eberbach
- Department of Orthopedic and Trauma Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
| | - David Fürst-Meroth
- Department of Orthopedic and Trauma Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Ferdinand Kloos
- Department of Orthopedic and Trauma Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Magnus Leible
- Freiburg Youth Academy, Sports-Club Freiburg e.V., Schwarzwaldstr. 193, 79117, Freiburg, Germany
| | - Valentin Bohsung
- Freiburg Youth Academy, Sports-Club Freiburg e.V., Schwarzwaldstr. 193, 79117, Freiburg, Germany
| | - Lisa Bode
- Department of Orthopedic and Trauma Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Markus Wenning
- Department of Orthopedic and Trauma Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Schmal Hagen
- Department of Orthopedic and Trauma Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.,Department of Orthopedic Surgery, University Hospital Odense, Sdr. Boulevard 29, 5000, Odense C, Denmark
| | - Gerrit Bode
- Sporthopaedicum Straubing, Bahnhofplatz 27, 94315, Straubing, Germany
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12
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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.
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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
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13
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Dallaudiere B, Sylvain B, Poussange N, Reboul G, Silvestre A, Meyer P, Hocquelet A, Pesquer L. Ultrasound feature variants of the adductor longus tendon in asymptomatic sportive subjects: Management implications. Eur J Radiol 2021; 144:109928. [PMID: 34562742 DOI: 10.1016/j.ejrad.2021.109928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/28/2021] [Accepted: 08/13/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The potential contribution of ultrasound (US) to diagnose adductor longus (AL) tendinopathy in athletic pubalgia requires clarification. We investigate US findings from AL tendons of asymptomatic participants to identify the range and prevalence of common US features not associated with groin pain. METHODS We consecutively enrolled 45 volunteers physically active participants with no history of groin pain. US features of bilateral AL tendons were investigated and recorded by two experienced musculoskeletal radiologists (MSKR) in accordance with a defined ultrasound protocol. Two other MSKRs retrospectively and independently analyzed all US images. RESULTS Ninety AL tendons from 45 participants (4/45 women) were imaged (average age: 35 years ±14.6; dominant side: 37/45 (82.2%) right, 8/45 (17.8%) left). Abnormalities on US were found in all 45 (100%) AL tendons, including: abnormal echogenicity (98.9%/100% respectively according to reader), loss of fibrillar structure (92.2%/97.8%), irregularities of the superficial paratendon (23.3%/30%), calcifications (22.2%/25.5%), and cortical erosion (52%/55.5%), with excellent inter-observer assessment. No AL tears or hyperemia at color Doppler were detectable. CONCLUSIONS AL tendon abnormalities were identified via US in 100% of our asymptomatic athletes. The significance of these US findings should be interpreted cautiously with respect to clinical presentation. On the other hand, there is a need for supplemental investigation into the clinical relevance of US AL tendon tears not present in the present asymptomatic athlete population.
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Affiliation(s)
- Benjamin Dallaudiere
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France; Département d'imagerie musculo-squelettique, centre hospitalier universitaire Pellegrin, place Amélie-Léon-Rabat, 33000 Bordeaux, France.
| | - Bise Sylvain
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Nicolas Poussange
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Gilles Reboul
- Centre de chirurgie orthopédique et sportive, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Alain Silvestre
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Philippe Meyer
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Arnaud Hocquelet
- Service de radiologie et d'imagerie diagnostique et interventionnelle, CHU Vaudois, 1011 Lausanne, Suisse
| | - Lionel Pesquer
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France
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Carton P, Filan D. Arthroscopic Correction of Femoroacetabular Impingement for Concomitant Inguinal Disruption in Athletes With Dual Pathology. Am J Sports Med 2021; 49:1741-1749. [PMID: 33914654 DOI: 10.1177/03635465211007144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Inguinal disruption and femoroacetabular impingement (FAI) are well-recognized sources of groin pain in athletes; however, the relationship between inguinal disruption and FAI remains unclear. In cases of dual pathology, where both entities coexist, there is no definitive consensus regarding which pathology should be prioritized for treatment in the first instance. PURPOSE (1) To examine the 2-year effectiveness and clinical outcome in athletes presenting with dual pathology in which the FAI component alone was treated with arthroscopic deformity correction. (2) To compare 2-year patient-reported outcome measures between athletes undergoing only hip arthroscopy (HA) and athletes undergoing groin repair and HA. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS All patients undergoing HA for the treatment of FAI with concomitant clinical signs of inguinal disruption at initial consultation were between 2010 and 2016 were included in this study. Inclusion criteria were male sex, age <40 years, and involvement in competitive sporting activity. Athletes with previous HA on the symptomatic side, Tönnis grade >1, or lateral center-edge angle <25° were excluded. Revision HA or subsequent groin surgery was documented. Outcome evaluation consisted of validated patient-reported outcome measures (modified Harris Hip Score; University of California, Los Angeles Activity Scale; 36-Item Short Form Health Survey; Western Ontario and McMaster Universities Osteoarthritis Index) completed preoperatively and a minimum 2 years postoperatively. The minimal clinically important difference was assessed by using a distribution-based technique (SD, 0.5) and an anchor-based technique (percentage of possible improvement). Level of satisfaction and return to play were assessed. RESULTS A total of 113 cases of dual pathology were included in 91 patients with a mean ± SD age of 26.3 ± 5.1 years. The index surgical procedure was HA for 104 cases (92%) and groin repair for 9 (8%). For patients undergoing HA as the index procedure, 98.1% (102/104 cases) were successfully followed up to establish survivorship. In 89.2% (91/102 cases), no additional groin surgery was required. In 11 cases (10.8%), additional groin surgery was required for persisting inguinal-related groin pain. At 2 years after the operation, there was no difference for any patient-reported outcome measure (P > .099), improvement from baseline (P > .070), or proportion of cases achieving the minimal clinically important difference (P > .120) between the HA-only group and the group undergoing HA and groin repair at any stage. There was also no difference between groups in terms of return-to-play rate (P = .509) or levels of satisfaction (pain, P = .204; performance, P = .345). CONCLUSION In patients with dual pathology, treatment of the FAI component alone using arthroscopic hip surgery results in a successful outcome without need for groin repair in 89.2% of cases. No statistical difference in clinical outcome 2 years after surgery was observed between athletes undergoing 1 procedure (HA alone) and those undergoing 2 procedures (HA and groin repair at any stage).
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Affiliation(s)
- Patrick Carton
- The Hip and Groin Clinic, UPMC Whitfield, Waterford, Ireland
| | - David Filan
- The Hip and Groin Clinic, UPMC Whitfield, Waterford, Ireland
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15
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Ogborn DI, Bellemare A, Bruinooge B, Brown H, McRae S, Leiter J. Comparison of Common Methodologies for the Determination of Knee Flexor Muscle Strength. Int J Sports Phys Ther 2021; 16:350-359. [PMID: 33842031 PMCID: PMC8016447 DOI: 10.26603/001c.21311] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 11/03/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Knee flexion strength may hold important clinical implications for the determination of injury risk and readiness to return to sport following injury and orthopedic surgery. A wide array of testing methodologies and positioning options are available that require validation prior to clinical integration. The purpose of this study was to 1) investigate the validity and test-retest reliability of isometric knee flexion strength measured by a fixed handheld dynamometer (HHD) apparatus compared to a Biodex Dynamometer (BD), 2) determine the impact of body position (seated versus supine) and foot position (plantar- vs dorsiflexed) on knee flexion peak torque and 3) establish the validity and test-retest reliability of the NordBord Hamstring Dynamometer. STUDY DESIGN Validity and reliability study, test-retest design. METHODS Forty-four healthy participants (aged 27 ± 4.8 years) were assessed by two raters over two testing sessions separated by three to seven days. Maximal isometric knee flexion in the seated and supine position at 90o knee flexion was measured with both a BD and an externally fixed HHD with the foot held in maximal dorsiflexion or in plantar flexion. The validity and test-retest reliability of eccentric knee flexor strength on the NordBord hamstring dynamometer was assessed and compared with isometric strength on the BD. RESULTS Level of agreement between HHD and BD torque demonstrated low bias (bias -0.33 Nm, SD of bias 13.5 Nm; 95% LOA 26.13 Nm, -26.79 Nm). Interrater reliability of the HHD was high, varying slightly with body position (ICC range 0.9-0.97, n=44). Isometric knee flexion torque was higher in the seated versus supine position and with the foot dorsiflexed versus plantarflexed. Eccentric knee flexion torque had a high degree of correlation with isometric knee flexion torque as measured via the BD (r=0.61-0.86). The NordBord had high test-retest reliability (0.993 (95%CI 0.983-0.997, n=19) for eccentric knee flexor strength, with an MDC95 of 26.88 N and 28.76 N for the left and right limbs respectively. CONCLUSION Common measures of maximal isometric knee flexion display high levels of correlation and test-retest reliability. However, values obtained by an externally fixed HHD are not interchangeable with values obtained via the BD. Foot and body position should be considered and controlled during testing. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Dan I Ogborn
- Department of Physical Therapy, University of Manitoba; Pan Am Clinic Foundation
| | - Alix Bellemare
- Pan Am Clinic Foundation; Faculty of Kinesiology and Recreation Management, University of Manitoba
| | - Brittany Bruinooge
- Department of Physical Therapy, University of Manitoba; Pan Am Clinic Foundation
| | | | - Sheila McRae
- Department of Physical Therapy, University of Manitoba; Pan Am Clinic Foundation
| | - Jeff Leiter
- Pan Am Clinic Foundation; Faculty of Kinesiology and Recreation Management, University of Manitoba
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16
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Pilkington JJ, Obeidallah R, Baltatzis M, Fullwood C, Jamdar S, Sheen AJ. Totally extraperitoneal repair for the 'sportsman's groin' via 'the Manchester Groin Repair': a comparison of elite versus amateur athletes. Surg Endosc 2020; 35:4371-4379. [PMID: 32909207 DOI: 10.1007/s00464-020-07930-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Surgery has a recognised role in the treatment of 'sportsman's groin'. This study hypothesises that elite athletes have a superior advantage in both pre- and post-op rehabilitation and therefore will present and resume sporting activities quicker. METHODS A retrospective analysis on a secure database of athletes presenting with groin pain that underwent surgery for 'inguinal disruption'. All data were explored via appropriate descriptive statistics and comparisons made between elite and amateur athletes. RESULTS All patients were male (n = 144). The median age 33 years (range 14-72). The median return to sporting activity was 4.5 weeks (range 2.0-16.0) with one amateur athlete being unable to return to sporting activity. Using the mean of both sides, a comparison of VAS pain scores at pre-operative and 1 month post-operative time points showed a significant reduction (p < 0.001). Comparing 'elite' versus 'amateur' athletes, significant differences were seen in patient age (median 26 vs 40 years; p < 0.001), lead time to clinic presentation (median 62.0 vs 111.5 days; p = 0.004), and time to return to sporting activity (4 vs 5 weeks; p = 0.019). Additional MRI findings within the groin girdle were found in 89 patients (66.4%) and 34 patients (23.6%) had an MRI finding within the adductor tendon. CONCLUSION The Manchester Groin Rrepair is an effective surgical management for 'inguinal disruption'. Elite athletes present quicker and return to sport sooner. Given the prevalence of other findings, a multidisciplinary approach to the 'sportsman's groin' is required.
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Affiliation(s)
- J J Pilkington
- Department of Academic Hernia Surgery, Manchester University NHS Foundation Trust, Manchester, UK.,Centre for Bioscience, Manchester Metropolitan University, Manchester, UK
| | - R Obeidallah
- Department of Academic Hernia Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - M Baltatzis
- Department of Academic Hernia Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - C Fullwood
- Research & Innovation, Manchester University NHS Foundation Trust, Manchester, UK.,Centre for Biostatistics, Manchester University, Manchester, UK
| | - S Jamdar
- Department of Academic Hernia Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - A J Sheen
- Department of Academic Hernia Surgery, Manchester University NHS Foundation Trust, Manchester, UK. .,Centre for Bioscience, Manchester Metropolitan University, Manchester, UK. .,Fortius Clinic, 17 Fitzhardinge street, London, UK.
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17
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Abstract
CLINICAL/METHODICAL ISSUE Osteitis pubis is one of the most common causes of chronic groin pain in many professional athletes. Symphysitis pubis with instability of the joint due to softening of the joint capsule and muscular imbalance of the corresponding muscles increases the instability of the sympyseal region, thus, resulting in a vicious cycle. STANDARD RADIOLOGICAL METHODS Magnetic resonance imaging (MRI). METHODICAL INNOVATIONS Optimized MRI sequence protocol with oblique (axial oblique) layers parallel to the linea arcuata of iliac bone together with large image field for depiction of the entire pelvis and high-resolution sequences focused on the symphysis pubis. PERFORMANCE Recently, the correlation between MRI signs of osteitis pubis and long-term clinical outcome in a group of professional soccer players was examined. In particular, edema in the peri-osseous tissue and isolated muscle lesions around the symphysis at the onset of symptoms were associated with partial recovery of the athletes. Furthermore, a significant association of increased normalized signal intensity in the pubic bone on STIR (short-tau inversion recovery) sequences (corresponding presence and signal intensity of bone marrow edema) and a poor complete clinical improvement was observed. ACHIEVEMENTS An optimized MRI protocol allows the diagnosis of osteitis pubis and provides important prognostic information. PRACTICAL RECOMMENDATIONS In case of clinical suspicion on osteitis pubis, MR imaging with an optimized sequence protocol should be performed.
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Lewis PB, Weber AE, Kuhns BD, Nho SJ. A Systematic Approach to Magnetic Resonance Imaging Interpretation of Sports Medicine Injuries of the Hip. JBJS Rev 2018; 6:e6. [PMID: 30496142 DOI: 10.2106/jbjs.rvw.17.00204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Paul B Lewis
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Alexander E Weber
- Hip Preservation Center, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois
| | - Benjamin D Kuhns
- Hip Preservation Center, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois
| | - Shane J Nho
- Hip Preservation Center, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois
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19
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Pezzotta G, Pecorelli A, Querques G, Biancardi S, Morzenti C, Sironi S. MRI characteristics of adductor longus lesions in professional football players and prognostic factors for return to play. Eur J Radiol 2018; 108:52-58. [DOI: 10.1016/j.ejrad.2018.09.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 09/10/2018] [Accepted: 09/15/2018] [Indexed: 10/28/2022]
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20
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Abstract
Traumatic and overuse hip injuries occur frequently in amateur and professional athletes. After clinical assessment, imaging plays an important role in diagnosis and in defining care management of these injuries. Ultrasonography (US) is being increasingly used in assessment of hip injuries because of the wide availability of US machines, the lower cost, and the unique real-time imaging capability, which allows both static and dynamic evaluation as well as guidance of point-of-care interventions such as fluid aspiration and steroid injection. Accurate diagnosis of hip injuries is often challenging, given the complex soft-tissue anatomy of the hip and the wide spectrum of injuries that can occur. To conduct a skillful US evaluation of hip injuries, physicians must have pertinent knowledge of the normal anatomy and should make judicious use of surface anatomy landmarks while using a compartmentalized diagnostic approach. In this article, common sports-related injuries of the anterior, lateral, and posterior hip compartments are discussed. This review includes assessment of joint effusion, acetabular labral tear, acute and chronic tendon injuries including tendinopathy, partial and full-thickness tears, snapping hip syndromes, relevant US-guided procedures, and some other conditions such as Morel-Lavallée lesion and perineal nodular induration. Principles of care management and current knowledge on imaging findings that may affect return to activity are also presented. Using an oriented US examination technique and having knowledge of the normal hip anatomy will help physicians characterize US findings of common sports-related hip injuries and make accurate diagnoses. Online supplemental material is available for this article. ©RSNA, 2018.
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Affiliation(s)
- Eugen Lungu
- From the Department of Radiology (E.L., N.J.B.), Department of Medicine (J.M.), and Research Center (N.J.B.), Centre Hospitalier de l'Université de Montréal, 1000 rue Saint-Denis, Montreal, QC, Canada H2X 0C1
| | - Johan Michaud
- From the Department of Radiology (E.L., N.J.B.), Department of Medicine (J.M.), and Research Center (N.J.B.), Centre Hospitalier de l'Université de Montréal, 1000 rue Saint-Denis, Montreal, QC, Canada H2X 0C1
| | - Nathalie J Bureau
- From the Department of Radiology (E.L., N.J.B.), Department of Medicine (J.M.), and Research Center (N.J.B.), Centre Hospitalier de l'Université de Montréal, 1000 rue Saint-Denis, Montreal, QC, Canada H2X 0C1
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21
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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.
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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
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22
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Hegazi TM, Belair JA, McCarthy EJ, Roedl JB, Morrison WB. Sports Injuries about the Hip: What the Radiologist Should Know. Radiographics 2017; 36:1717-1745. [PMID: 27726744 DOI: 10.1148/rg.2016160012] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Injuries of the hip and surrounding structures represent a complex and commonly encountered scenario in athletes, with improper diagnosis serving as a cause of delayed return to play or progression to a more serious injury. As such, radiologists play an essential role in guiding management of athletic injuries. Familiarity with hip anatomy and the advantages and limitations of various imaging modalities is of paramount importance for accurate and timely diagnosis. Magnetic resonance (MR) imaging is often the modality of choice for evaluating many of the injuries discussed, although preliminary evaluation with conventional radiography and use of other imaging modalities such as ultrasonography (US), computed tomography, and bone scintigraphy may be supplementary or preferred in certain situations. Stress fractures, thigh splints, and posterior hip dislocations are important structural injuries to consider in the athlete, initially imaged with radiographs and often best diagnosed with MR imaging. Apophyseal injuries are particularly important to consider in young athletes and may be acute or related to chronic repetitive microtrauma. Femoroacetabular impingement has been implicated in development of labral tears and cartilage abnormalities. Tear of the ligamentum teres is now recognized as a potential cause of hip pain and instability, best evaluated with MR arthrography. Greater trochanteric pain syndrome encompasses a group of conditions leading to lateral hip pain, with US playing an increasingly important role for both evaluation and image-guided treatment. Muscle injuries and athletic pubalgia are common in athletes. Lastly, snapping hip syndrome and Morel-Lavallée lesions are two less common but nonetheless important considerations. ©RSNA, 2016.
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Affiliation(s)
- Tarek M Hegazi
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, 1079A Main Building, Philadelphia, PA 19107 (T.M.H., J.A.B., E.J.M., J.B.R., W.B.M.); and Department of Radiology, University of Dammam, Dammam, Saudi Arabia (T.M.H.)
| | - Jeffrey A Belair
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, 1079A Main Building, Philadelphia, PA 19107 (T.M.H., J.A.B., E.J.M., J.B.R., W.B.M.); and Department of Radiology, University of Dammam, Dammam, Saudi Arabia (T.M.H.)
| | - Eoghan J McCarthy
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, 1079A Main Building, Philadelphia, PA 19107 (T.M.H., J.A.B., E.J.M., J.B.R., W.B.M.); and Department of Radiology, University of Dammam, Dammam, Saudi Arabia (T.M.H.)
| | - Johannes B Roedl
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, 1079A Main Building, Philadelphia, PA 19107 (T.M.H., J.A.B., E.J.M., J.B.R., W.B.M.); and Department of Radiology, University of Dammam, Dammam, Saudi Arabia (T.M.H.)
| | - William B Morrison
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, 1079A Main Building, Philadelphia, PA 19107 (T.M.H., J.A.B., E.J.M., J.B.R., W.B.M.); and Department of Radiology, University of Dammam, Dammam, Saudi Arabia (T.M.H.)
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23
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Osteitis pubis in professional football players: MRI findings and correlation with clinical outcome. Eur J Radiol 2017; 94:46-52. [PMID: 28941759 DOI: 10.1016/j.ejrad.2017.07.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/13/2017] [Accepted: 07/17/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Osteitis pubis (OP), a common pathology in elite athletes, is an aseptic inflammatory process of the pubic symphysis bone, and may involve surrounding soft tissues, tendons and muscles. OP is typically characterized by (often recurring) groin pain and is an important cause of time-off from sports activity in athletes. Aim of this retrospective study was to analyze magnetic resonance imaging (MRI) findings in professional football players with clinical diagnosis of OP and to correlate MRI findings with clinical outcome. MATERIAL AND METHODS All professional football players (23 males, 1 female; mean age: 21±3.7years; range: 16-30 years) with groin pain and clinical diagnosis of OP, who underwent pelvic MRI in our institution were retrospectively analyzed. The MR images were analyzed regarding the presence of bone marrow edema and its extension, whether fluid in the symphysis pubis or periarticular soft tissue edema with a rim-like periosteal distribution or edema in the muscles located around the symphyseal joint were present, whether degenerative changes of the symphysis pubis and of signs of symphyseal instability were encountered. A quantitative measurement of the signal intensity in bone marrow edema on 3T STIR sequences was performed, normalizing these values to the mean signal intensity values in the ipsilateral iliopsoas muscle. All patients were classified according to a 3-point grading scale. For each patient, both the symptoms 18 months after the initial MRI examination, the duration of time off from playing football and the kind of treatment applied were evaluated. RESULTS Among all professional athletes, in 20/24 (83.3%) MRI showed signs of OP with bone marrow edema at the pubic bone. 12 of these patients showed complete clinical recovery without any symptoms after 18 months, while in 8 patients partial recovery with persistence of groin pain during higher sports activity was observed. Patients with edema in periarticular soft tissues or in the muscles around the symphyseal joint on MRI at the beginning of symptoms presented significantly more often with a partial recovery after returning to high sports activity (p=0.042 and p=0.036, respectively). A partial recovery was also significantly associated with higher normalized mean signal intensity values in bone marrow edema on STIR sequences at the beginning of symptoms (mean=4.77±1.63 in the group with partial recovery vs. mean=2.86±0.45 in the group with complete recovery; p=0.0019). No significant association was noticed between MRI findings and time of abstinence from high sports activity, as well as between the 3-point grading scale and the time off from high sport activity and recovery at 18 months. CONCLUSIONS Edema in periarticular soft tissues, edema with extension to the muscles located around the symphyseal joint, as well as higher normalized signal intensity values in bone marrow edema on STIR sequences in the pubic bones at the beginning of groin pain are the most reliable MRI findings of a poor clinical long-term outcome of OP in professional football players and should be regarded as negative prognostic factors.
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24
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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.
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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
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25
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Non-surgical treatment of pubic overload and groin pain in amateur football players: a prospective double-blinded randomised controlled study. Knee Surg Sports Traumatol Arthrosc 2017; 25:1958-1966. [PMID: 28093636 DOI: 10.1007/s00167-017-4423-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 01/03/2017] [Indexed: 01/16/2023]
Abstract
PURPOSE The incidence of groin pain in athletes is steadily increasing. Symptomatic pubic overload with groin pain and aseptic osteitis pubis represent well-known and frequently misdiagnosed overuse injuries in athletes. This study investigated the benefits of standardised non-surgical treatment for swift return-to-football. METHODS In a prospective double-blinded controlled study, 143 amateur football players with groin pain as well as radiological signs and clinical symptoms of pubic overload were analysed for 1 year. Two randomised study groups participated in an intensive physical rehabilitation programme, either with or without shock wave therapy. The control group did not participate in any standardised rehabilitation programme but only stopped participating in sports activity. Follow-up examinations took place 1, 3 months and 1 year after the beginning of therapy. Endpoints were visual analogue scale (VAS), functional tests, the time of return-to-football, recurrent complaints and changes in the MR image. RESULTS Forty-four football players with groin pain and aseptic osteitis pubis were randomised into two study groups; 26 received shock wave therapy, 18 did not. Clinical examination showed pubic overload as a multi-located disease. Players receiving shock wave therapy showed earlier pain relief in the VAS (p < 0.001) and returned to football significantly earlier (p = 0.048) than players without this therapy. Forty-two of 44 players of both study groups returned to football within 4 months after the beginning of therapy and had no recurrent groin pain within 1 year after trauma. Fifty-one players of the control group returned to football after 240 days (p < 0.001), of whom 26 (51%) experienced recurrent groin pain. Follow-up MRI scans did not show any effect of shock wave therapy. CONCLUSION Non-surgical therapy is successful in treating pubic overload and osteitis pubis in athletes. Shock wave therapy as a local treatment significantly reduced pain, thus enabling return-to-football within 3 months after trauma. Early and correct diagnosis is essential for successful intensive physiotherapy. LEVEL OF EVIDENCE I.
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26
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Abstract
CONTEXT Evaluation of groin pain in athletes may be challenging as pain is typically poorly localized and the pubic symphyseal region comprises closely approximated tendons and muscles. As such, magnetic resonance imaging (MRI) and ultrasound (US) may help determine the etiology of groin pain. EVIDENCE ACQUISITION A PubMed search was performed using the following search terms: ultrasound, magnetic resonance imaging, sports hernia, athletic pubalgia, and groin pain. Date restrictions were not placed on the literature search. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS MRI is sensitive in diagnosing pathology in groin pain. Not only can MRI be used to image rectus abdominis/adductor longus aponeurosis and pubic bone pathology, but it can also evaluate other pathology within the hip and pelvis. MRI is especially helpful when groin pain is poorly localized. Real-time capability makes ultrasound useful in evaluating the pubic symphyseal region, as it can be used for evaluation and treatment. CONCLUSION MRI and US are valuable in diagnosing pathology in athletes with groin pain, with the added utility of treatment using US-guided intervention. Strength-of Recommendation Taxonomy: C.
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Affiliation(s)
- Susan C Lee
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Yoshimi Endo
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York.,Weill Medical College of Cornell University, New York, New York
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York.,Weill Medical College of Cornell University, New York, New York
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Bisciotti GN, Volpi P, Zini R, Auci A, Aprato A, Belli A, Bellistri G, Benelli P, Bona S, Bonaiuti D, Carimati G, Canata GL, Cassaghi G, Cerulli S, Delle Rose G, Di Benedetto P, Di Marzo F, Di Pietto F, Felicioni L, Ferrario L, Foglia A, Galli M, Gervasi E, Gia L, Giammattei C, Guglielmi A, Marioni A, Moretti B, Niccolai R, Orgiani N, Pantalone A, Parra F, Quaglia A, Respizzi F, Ricciotti L, Pereira Ruiz MT, Russo A, Sebastiani E, Tancredi G, Tosi F, Vuckovic Z. Groin Pain Syndrome Italian Consensus Conference on terminology, clinical evaluation and imaging assessment in groin pain in athlete. BMJ Open Sport Exerc Med 2016; 2:e000142. [PMID: 28890800 PMCID: PMC5566259 DOI: 10.1136/bmjsem-2016-000142] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 12/14/2022] Open
Abstract
The nomenclature and the lack of consensus of clinical evaluation and imaging assessment in groin pain generate significant confusion in this field. The Groin Pain Syndrome Italian Consensus Conference has been organised in order to prepare a consensus document regarding taxonomy, clinical evaluation and imaging assessment for groin pain. A 1-day Consensus Conference was organised on 5 February 2016, in Milan (Italy). 41 Italian experts with different backgrounds participated in the discussion. A consensus document previously drafted was discussed, eventually modified, and finally approved by all members of the Consensus Conference. Unanimous consensus was reached concerning: (1) taxonomy (2) clinical evaluation and (3) imaging assessment. The synthesis of these 3 points is included in this paper. The Groin Pain Syndrome Italian Consensus Conference reached a consensus on three main points concerning the groin pain syndrome assessment, in an attempt to clarify this challenging medical problem.
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Affiliation(s)
- G N Bisciotti
- Qatar Orthopedic and Sport Medicine Hospital, Doha, Qatar
| | - P Volpi
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy.,FC Internazionale, Milan, Italy
| | - R Zini
- Azienda Ospedaliera "Ospedale San Salvatore", Pesaro, Italy
| | - A Auci
- Kinemove Rehabilitation Center, Pontremoli, La Spezia, Italy
| | | | - A Belli
- FC Internazionale, Milan, Italy
| | | | | | - S Bona
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | - D Bonaiuti
- Fisioclinic Centro Medico Polispecialistico, Pesaro, Italy
| | - G Carimati
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | | | - G Cassaghi
- Kinemove Rehabilitation Center, Pontremoli, La Spezia, Italy
| | - S Cerulli
- Institute of Sports Medicine of Turin, Italy
| | - G Delle Rose
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | | | - F Di Marzo
- Azienda Ospedaliera Universitaria di Udine, Italy
| | | | - L Felicioni
- Ospedale della Misericordia, Grosseto, Italy
| | | | - A Foglia
- Studio di fisioterapia Riabilita, Pesaro, Italy
| | - M Galli
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | | | - L Gia
- Azienda Ospedaliera Universitaria di Udine, Italy
| | | | - A Guglielmi
- Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - A Marioni
- Azienda Policlinico Università di Bari, Bari, Italy
| | | | | | - N Orgiani
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | | | - F Parra
- Kinemove Rehabilitation Center, Pontremoli, La Spezia, Italy
| | - A Quaglia
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | - F Respizzi
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | - L Ricciotti
- Kinemove Rehabilitation Center, Pontremoli, La Spezia, Italy
| | | | | | | | | | - F Tosi
- Department of Knee Orthopedic and Sports Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | - Z Vuckovic
- Qatar Orthopedic and Sport Medicine Hospital, Doha, Qatar
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Abstract
This article outlines adductor-related groin pain, pubic-related groin pain, inguinal-related groin pain, and iliopsoas-related groin pain, with a description of the corresponding functional anatomy and imaging findings. The imaging has been described mainly in terms of MR imaging findings as this is the principal imaging modality used to investigate groin pain, although plain radiographs and ultrasound can be very useful adjuncts in specific circumstances, especially if an alternative pathology needs to be excluded.
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Affiliation(s)
- Annu Chopra
- X-Ray department, Musculoskeletal Centre, Leeds Teaching Hospitals, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK
| | - Philip Robinson
- X-Ray department, Musculoskeletal Centre, Leeds Teaching Hospitals, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK; Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals, Chapel Allerton Hospital, Chapletown Road, Leeds LS7 4SA, UK.
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Abstract
Athletic pubalgia, or "sports hernia", represents a constellation of pathologic conditions occurring at and around the pubic symphysis. These injuries are primarily seen in athletes or those involved in athletic activity. In this article, we review the sonographic appearance of the relevant complex anatomy, scanning technique for ultrasound evaluation of athletic pubalgia, and the sonographic appearances of associated pathologic conditions.
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Dimitrakopoulou A, Schilders E. Sportsman's hernia? An ambiguous term. J Hip Preserv Surg 2016; 3:16-22. [PMID: 27026822 PMCID: PMC4808262 DOI: 10.1093/jhps/hnv083] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 10/29/2015] [Accepted: 12/24/2015] [Indexed: 11/14/2022] Open
Abstract
Groin pain is common in athletes. Yet, there is disagreement on aetiology, pathomechanics and terminology. A plethora of terms have been employed to explain inguinal-related groin pain in athletes. Recently, at the British Hernia Society in Manchester 2012, a consensus was reached to use the term inguinal disruption based on the pathophysiology while lately the Doha agreement in 2014 defined it as inguinal-related groin pain, a clinically based taxonomy. This review article emphasizes the anatomy, pathogenesis, standard clinical assessment and imaging, and highlights the treatment options for inguinal disruption.
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Affiliation(s)
- Alexandra Dimitrakopoulou
- 1. The London Hip Arthroscopy Centre, The Wellington Hospital, St Johns Wood, London, NW8 9LE, UK and
| | - Ernest Schilders
- 1. The London Hip Arthroscopy Centre, The Wellington Hospital, St Johns Wood, London, NW8 9LE, UK and ; 2. Fortius Clinic, 17 Fitzhardinge Street, London W1H 6EQ, UK
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Tansey RJ, Benjamin-Laing H, Jassim S, Liekens K, Shankar A, Haddad FS. Successful return to high-level sports following early surgical repair of combined adductor complex and rectus abdominis avulsion. Bone Joint J 2015; 97-B:1488-92. [DOI: 10.1302/0301-620x.97b11.32924] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hip and groin injuries are common in athletes who take part in high level sports. Adductor muscle tendon injuries represent a small but important number of these injuries. Avulsion of the tendons attached to the symphysis pubis has previously been described: these can be managed both operatively and non-operatively. We describe an uncommon variant of this injury, namely complete avulsion of the adductor sleeve complex: this includes adductor longus, pectineus and rectus abdominis. We go on to describe a surgical technique which promotes a full return to the pre-injury level of sporting activity. Over a period of ten years, 15 high-level athletes with an MRI-confirmed acute adductor complex avulsion injury (six to 34 days old) underwent surgical repair. The operative procedure consisted of anatomical re-attachment of the avulsed tissues in each case and mesh reinforcement of the posterior inguinal wall in seven patients. All underwent a standardised rehabilitation programme, which was then individualised to be sport-specific. One patient developed a superficial wound infection, which was successfully treated with antibiotics. Of the 15 patients, four complained of transient local numbness which resolved in all cases. All patients (including seven elite athletes) returned to their previous level of participation in sport. Cite this article: Bone Joint J 2015;97-B:1488–92.
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Affiliation(s)
- R. J. Tansey
- University College London Hospitals, 235
Euston Rd, London, NW1
2BU, UK
| | - H. Benjamin-Laing
- University College London Hospitals, 235
Euston Rd, London, NW1
2BU, UK
| | - S. Jassim
- University College London Hospitals, 235
Euston Rd, London, NW1
2BU, UK
| | | | - A. Shankar
- University College London Hospitals, 235
Euston Rd, London, NW1
2BU, UK
| | - F. S. Haddad
- University College London Hospitals, 235
Euston Rd, London, NW1
2BU, UK
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Angoules AG. Osteitis pubis in elite athletes: Diagnostic and therapeutic approach. World J Orthop 2015; 6:672-679. [PMID: 26495244 PMCID: PMC4610909 DOI: 10.5312/wjo.v6.i9.672] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/13/2015] [Accepted: 08/07/2015] [Indexed: 02/06/2023] Open
Abstract
Osteitis pubis (OP) is a debilitating overuse syndrome characterizing by pelvic pain and local tenderness over the pubic symphysis commonly encountered in athletes often involved in kicking, twisting and cutting activities in sports such as soccer and rugby and to a lesser degree distance running. It is a common source of groin pain in elite athletes attributable to pubis sympysis instability as the result of microtrauma caused by repetitive muscle strains on pubic bones. Diagnosis is based mainly on detailed sports history and a meticulous clinical examination, although occasionally is difficult to distinguish this nosological entity from other pathologies affecting the involved area which may occur concomitantly in the same patient. Radiologic examinations such as plain radiographs, magnetic resonance imaging and 3 phase bone isotope scanning may be helpful to differentiate from other clinical entities with similar clinical presentation. Most cases respond well to conservative treatment which includes several physical modalities and especially a progressive rehabilitation programmed individualized to each one of patients diagnosed with OP. Local injection therapies have been also been proposed as a non-operative therapeutic option for the efficient management of these patients. In refractory cases, surgical therapeutic strategies are warranted. These include several open or minimally invasive surgical interventions such as arthroscopic or open symphysis curettage, wedge or total resection of pubic sympysis, polypropylene mesh placement and pubic fusion. In this review a critical analysis of OP in elite athletes is performed with special focus on current concepts of diagnosis and management of this source of athletic groin pain.
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Morphometric variability of pyramidalis muscle and its clinical significance. Surg Radiol Anat 2015; 38:285-92. [PMID: 26364033 DOI: 10.1007/s00276-015-1550-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 08/28/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The goal of the study is to analyze the morphometric diversity of the pyramidalis muscle (PM) and to evaluate how it is affected by gender and side of occurrence. MATERIALS AND METHODS Ninety-six (50 male and 46 female) formalin-embalmed Greek cadavers were dissected. RESULTS The PM was present in 93.8 %, usually bilaterally (79.2 %) than unilaterally (14.6 %) (p = 0.003) and more frequently in females (91.3 %) than in males (68 %) (p = 0.0001). Side symmetry was detected. The mean length of PM in males and females was 8.37 ± 2.80 and 6.18 ± 1.64 cm on the right and 7.50 ± 2.66 and 6.56 ± 1.68 cm on the left side. Male predominance existed on the right and left-sided PM lengths (p = 0.0001 and p = 0.054). The mean width of the right-sided PMs in males and females was 1.61 ± 0.55 and 1.50 ± 0.44 cm and the left-sided 1.56 ± 0.53 and 1.55 ± 0.38 cm without gender dimorphism. The positive correlation between the PM length and width indicates a symmetrical muscle augmentation on the two dimensions. CONCLUSIONS The study demonstrates that the PM is almost constant in Greeks. Among populations the muscle morphometric variability, its clinical significance and its variable uses will help surgeons when intervening in the lower abdominal wall.
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Pesquer L, Reboul G, Silvestre A, Poussange N, Meyer P, Dallaudière B. Imaging of adductor-related groin pain. Diagn Interv Imaging 2015; 96:861-9. [PMID: 25823982 DOI: 10.1016/j.diii.2014.12.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 12/22/2014] [Accepted: 12/30/2014] [Indexed: 10/23/2022]
Abstract
Groin pain is a common condition in athletes and results from various causes. Osteitis pubis, adductor dysfunction, inguinal hernia, or a combination of all three entities, generally explains the onset of symptoms. Adductor longus tendinopathy is the main cause of adductor-related groin pain. It leads to a significant reduction of sports participation and can require surgical management. Diagnosis is based on ultrasonography and magnetic resonance imaging. Asymptomatic findings (tendinosis, calcifications, cortical erosions) are common in athletes and care should be taken when assessing groin pain. The most specific sign of tendinopathy is an intratendinous tear of the adductor longus.
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Affiliation(s)
- L Pesquer
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France.
| | - G Reboul
- Centre de chirurgie orthopédique et sportive, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - A Silvestre
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - N Poussange
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - P Meyer
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - B Dallaudière
- 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
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The Role of Pubic Symphyseal CT Arthrography in the Imaging of Athletic Pubalgia. AJR Am J Roentgenol 2014; 203:1063-8. [DOI: 10.2214/ajr.13.12050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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36
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Gallo RA, Silvis ML, Smetana B, Stuck D, Lynch SA, Mosher TJ, Black KP. Asymptomatic hip/groin pathology identified on magnetic resonance imaging of professional hockey players: outcomes and playing status at 4 years' follow-up. Arthroscopy 2014; 30:1222-8. [PMID: 24996873 DOI: 10.1016/j.arthro.2014.04.100] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 04/07/2014] [Accepted: 04/23/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical outcomes and playing status of professional hockey players 4 years after they underwent bilateral magnetic resonance imaging (MRI) of asymptomatic hips. METHODS Twenty-one professional hockey players with no previous hip/groin pain underwent hip/pelvis MRI. Each MRI study was evaluated by 3 subspecialty-trained musculoskeletal radiologists for alpha-angle measurement and the presence of adductor-abdominal rectus abnormalities, acetabular labral tears, osteochondral lesions of the femoral head or acetabulum, hip effusion, adjacent muscle contusions or strain injury, and stress fractures. The MRI findings of the players were previously published. In the present study, each athlete was followed up by (1) completion of a questionnaire assessing hip/groin dysfunction at 1 and 2 years' follow-up and (2) number of games played over the course of the next 4 years. A significant difference in the number of games played was considered when a player missed more than 5 games compared with the index year. RESULTS We enrolled 21 players in the study. Of these players, 4 had no abnormality bilaterally, 10 had muscle strain and/or tendinosis in 1 or both hips, and 15 had labral tears identified in 1 or both hips. Eight players had a combination of labral tears and muscle strain/tendinosis. Of 21 professional hockey players, 16 (76%) and 14 (67%) were available at 1 and 2 years' follow-up, respectively. Nineteen of 21 players (90%) continued to play professional hockey at 4 years' follow-up. The development of any hip and/or pelvis symptoms occurred in only 3 players (14%) within 4 years. Only 1 of the 3 players missed any games because of hip and/or pelvis symptoms. The affected player missed several games because of proximal iliotibial band symptoms that occurred in the third year after MRI. CONCLUSIONS Hip/pelvis pathology is commonly uncovered on MRI of asymptomatic hockey players; however, this pathology does not produce symptoms or result in missed games within 4 years in most players. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Robert A Gallo
- Department of Orthopedics and Rehabilitation, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A..
| | - Matthew L Silvis
- Department of Orthopedics and Rehabilitation, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A.; Department of Family and Community Medicine, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
| | - Brandon Smetana
- Department of Orthopaedics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Dan Stuck
- Hershey Bears Hockey Club, Hershey, Pennsylvania, U.S.A
| | - Scott A Lynch
- Department of Orthopedics and Rehabilitation, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
| | - Timothy J Mosher
- Department of Radiology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
| | - Kevin P Black
- Department of Orthopedics and Rehabilitation, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
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MRI of the Hip: Important Injuries of the Adult Athlete. CURRENT RADIOLOGY REPORTS 2014. [DOI: 10.1007/s40134-014-0051-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Robinson P, Grainger AJ, Hensor EMA, Batt ME, O'Connor PJ. Do MRI and ultrasound of the anterior pelvis correlate with, or predict, young football players’ clinical findings? A 4-year prospective study of elite academy soccer players. Br J Sports Med 2014; 49:176-82. [DOI: 10.1136/bjsports-2013-092932] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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A European survey on the aetiology, investigation and management of the "sportsman's groin". Hernia 2013; 18:803-10. [PMID: 24249070 DOI: 10.1007/s10029-013-1178-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 10/31/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION A sportsman's groin has no accepted definition or consensus on treatment. The aim of this study was to assess current opinion among a large body of European surgeons using an online survey. METHODS An online questionnaire comprising 16 multiple-choice questions was sent by email to general surgeons in Europe. The survey was live from the 6th to 30th September 2011. RESULTS In total 143 responses were received. One hundred and six respondents (74 %) expressed experience in managing this condition. The majority (91 %) managed <26 cases per year. Posterior wall weakness (53 %), pubic tendinitis (43 %), nerve entrapment (37 %) and conjoint tendon injury (36 %) were the commonest aetiological factors described. Preferred diagnostic investigations were ultrasound of the groin (44 %) and MRI of the pelvis (29 %). The most common initial treatment (91 % of respondents) was conservative measures (rest and analgesia) for a maximum of 6-month period. When surgery was undertaken, Lichtenstein repair (29 %), TEP (27 %), TAPP (20 %), and posterior wall repair (21 %) were the commonest procedures. The majority (95 %) of respondents would not offer bilateral surgery for those presenting with unilateral groin pain. CONCLUSIONS Most European surgeons see <26 cases of "sportsman's groin" per year, which is in keeping with the low incidence of this condition. There remains wide variation in its investigation and management, which reflects the differences in opinion on its aetiology. The majority of surgeons agree that surgery is not the only treatment option available, but there is little consensus on the optimal management.
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Sheen AJ, Stephenson BM, Lloyd DM, Robinson P, Fevre D, Paajanen H, de Beaux A, Kingsnorth A, Gilmore OJ, Bennett D, Maclennan I, O'Dwyer P, Sanders D, Kurzer M. ‘Treatment of the Sportsman's groin’: British Hernia Society's 2014 position statement based on the Manchester Consensus Conference. Br J Sports Med 2013; 48:1079-87. [DOI: 10.1136/bjsports-2013-092872] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Imaging assessment of groin pain. Musculoskelet Surg 2013; 97 Suppl 2:S109-16. [PMID: 23949932 DOI: 10.1007/s12306-013-0278-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 06/10/2013] [Indexed: 10/26/2022]
Abstract
Groin pain is a common condition in athletes, especially those who play certain sports, for instance soccer, ice hockey, fencing which request rapid acceleration and frequent changes of movement. This condition represents a diagnostic difficulty for the radiologist due to either the anatomical pubic region complexity than the many causes that can be a source of pain, because the groin pain can be determined by conditions affecting the bony structures, cartilage and muscle tendons that are part of the proper pubis but also from those involving the hip. The approach to the groin through diagnostic imaging is multidisciplinary: The study of the patient is performed by traditional radiographs, ultrasound examination, magnetic resonance imaging or computed tomography, based on clinical suspicion, and each of these methods provides different results depending on the disease in question. The purpose of this article is to examine what are the optimal imaging techniques to investigate the various diseases affecting the patient with groin pain.
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44
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Hip and Groin Pain in the Professional Athlete. Can Assoc Radiol J 2012; 63:87-99. [DOI: 10.1016/j.carj.2010.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 10/20/2010] [Accepted: 11/09/2010] [Indexed: 01/01/2023] Open
Abstract
Hip and groin pain is a common condition in professional athletes and may result from an acute injury or from chronic, repetitive trauma. It is responsible for significant morbidity, which leads to time away from training and competition, and may result in a career-ending injury. The anatomic and biomechanical causes for hip and groin injuries are among the most complex and controversial in the musculoskeletal system. This makes clinical differentiation and subsequent management difficult because of the considerable overlap of symptoms and signs. This review article will evaluate several pathologic conditions of the hip and groin in athletes, divided into acute (secondary to single event) and chronic (secondary to altered biomechanical load or repetitive microtrauma) injuries, with an emphasis on imaging in the diagnosis of these injuries. Appropriate use of imaging along with clinical findings can allow accurate diagnosis and subsequent appropriate management of these patients to ultimately allow return to athletic activity.
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Litwin DE, Sneider EB, McEnaney PM, Busconi BD. Athletic Pubalgia (Sports Hernia). Clin Sports Med 2011; 30:417-34. [DOI: 10.1016/j.csm.2010.12.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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46
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Silvis ML, Mosher TJ, Smetana BS, Chinchilli VM, Flemming DJ, Walker EA, Black KP. High prevalence of pelvic and hip magnetic resonance imaging findings in asymptomatic collegiate and professional hockey players. Am J Sports Med 2011; 39:715-21. [PMID: 21233405 DOI: 10.1177/0363546510388931] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Prior retrospective studies have reported magnetic resonance imaging (MRI) findings of common adductor-abdominal rectus enthesopathy and acetabular labral tear in athletes treated for athletic pubalgia and hip pain. The true prevalence of these findings and association with symptoms in this population is unknown. PURPOSE This study was undertaken to determine the prevalence of pelvic and hip MRI findings and association with clinical symptoms in professional and collegiate hockey players. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS The study included 21 professional and 18 collegiate hockey players. Self-reported symptoms were measured using a modified Oswestry Disability Questionnaire. Participants underwent 3-T MRI evaluation of the pelvis and hips. The MRI scans were interpreted independently by 3 musculoskeletal radiologists in 2 sessions separated by 3 months using a 5-point Likert scale to assess for features associated with common adductor-abdominal rectus dysfunction and hip pathology. To estimate prevalence, MRI findings rated 4 or higher on 4 of the 6 interpretations were considered positive. A variance component analysis was applied to determine intrareader and interreader reliability and the lower 95% confidence limits (CLs). RESULTS No participants reported symptoms related to pelvic or hip disorders. The MRI findings of common adductor-abdominal rectus dysfunction were observed in 14 of 39 participants (36%) and hip pathologic changes in 25 of 39 (64%). There was moderate agreement between readings, with intrareader and interreader reliabilities ranging from 0.37 to 1.00. The interreader reliability was less for evaluation of hip pathologic abnormalities than for groin pathologic abnormalities, with the lowest reliability observed in reporting of hip osteochondral lesions (0.37 with lower 95% CL of 0.22) and fluid in the primary cleft (0.45 with lower 95% CL of 0.29) and perfect reliability in the absence of effusion and abdominal rectus tendon tears. Overall, 30 of 39 (77%) asymptomatic hockey players demonstrated MRI findings of hip or groin pathologic abnormalities. CONCLUSION Given the high prevalence of MRI findings in asymptomatic hockey players, it is necessary to cautiously interpret the significance of these findings in association with clinical presentation. Future investigations will determine whether these asymptomatic findings predict future disabilities.
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Affiliation(s)
- Matthew L Silvis
- Pennsylvania State Milton S. Hershey Medical Center, 17033, USA.
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COMPARATIVE STUDY BETWEEN THE PUBIS OF ASYMPTOMATIC ATHLETES AND NON-ATHLETES WITH MRI. Rev Bras Ortop 2010; 45:596-600. [PMID: 27026970 PMCID: PMC4799173 DOI: 10.1016/s2255-4971(15)30309-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2010] [Accepted: 04/26/2010] [Indexed: 11/22/2022] Open
Abstract
Objective: To compare the magnetic resonance imaging findings from the pubis of professional soccer players without any history or clinical findings of groin pain, and from sedentary individuals, also without symptoms, and to determine the prevalence of changes compatible with pubic overload. Methods: Nineteen professional soccer players without complaints of groin pain and seventeen sedentary individuals, also asymptomatic, underwent magnetic resonance imaging of the pubis. The results from the examinations were analyzed regarding the presence of degenerative changes, boned medullary edema and tendinopathy, and the two study groups were compared. Results: High prevalence of bone edema, tendinopathy and degenerative findings in the pubic symphysis was seen in the athletes, with statistically significant higher odds ratios and relative risk in the population studied. Conclusion: Professional soccer players are at a higher risk of developing changes in the pubic region, shown in magnetic resonance images, compared with sedentary individuals. These findings are not necessarily caused by groin pain, and are probably related to intense exertion.
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Review: imaging of groin pain in the athlete. Skeletal Radiol 2010; 39:629-44. [PMID: 19711074 DOI: 10.1007/s00256-009-0768-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Revised: 06/28/2009] [Accepted: 07/17/2009] [Indexed: 02/02/2023]
Abstract
Chronic groin pain is a common entity in the sporting population and causes considerable morbidity. The differential diagnosis is wide, and this article presents a review of the common causes with particular reference to anatomy, ultrasound and magnetic resonance imaging (MRI) findings.
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Kjellin I, Stadnick ME, Awh MH. Orthopaedic magnetic resonance imaging challenge: apophyseal avulsions at the pelvis. Sports Health 2010; 2:247-51. [PMID: 23015945 PMCID: PMC3445104 DOI: 10.1177/1941738109347976] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Apophyseal avulsion injuries of the hip and pelvis are frequent athletic injuries in children and adolescents, most commonly associated with explosive movement or sprinting. This article details typically encountered apophyseal injuries and their appearance on magnetic resonance imaging.
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MacMahon PJ, Hogan BA, Shelly MJ, Eustace SJ, Kavanagh EC. Imaging of groin pain. Magn Reson Imaging Clin N Am 2010; 17:655-66, vi. [PMID: 19887295 DOI: 10.1016/j.mric.2009.06.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Groin pain is a commonly encountered problem in musculoskeletal radiology. The diagnosis can be difficult to establish, based on the complex interconnected anatomy at the pubic symphysis and surrounding structures. The differential diagnosis is therefore broad, and diagnostic imaging is crucial in reaching the correct diagnosis, thus allowing appropriate therapy to be instituted. This article reviews the relevant anatomy and differential diagnoses encountered in overuse injuries of the groin. The common mechanisms of injury, presenting symptoms, and imaging findings for each diagnosis are addressed.
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Affiliation(s)
- Peter J MacMahon
- Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
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