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Imaging of Athletic Groin Pain

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Sports Hernia and Athletic Pubalgia

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Abstract

Diagnostic imaging supplements the history and physical examination in athletes with groin pain. Magnetic resonance imaging (MRI) accurately depicts the anatomy of the pubic bones and pubic symphysis, the rectus abdominis–adductor longus aponeurosis, and the associated abdominal, pelvic, and thigh muscles. The pattern of injuries to these structures can support or refute the suspected clinical diagnosis, and may help guide treatment planning. Some MRI findings are relatively nonspecific, seen in patients with different causes of pain or even in asymptomatic athletes. Other features are characteristic of a particular injury. This chapter will review the MRI appearances of the normal groin and pubic anatomy, as well as the imaging features of the major categories of sports-related groin injuries.

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References

  1. Omar IM, Zoga AC, Kavanagh EC, Koulouris G, Bergin D, Gopez AG, et al. Athletic pubalgia and “sports hernia”: optimal MR imaging technique and findings. Radiographics. 2008;28(5):1415–38.

    Article  PubMed  Google Scholar 

  2. Robinson P, Salehi F, Grainger A, Clemence M, Schilders E, O’Connor P, et al. Cadaveric and MRI study of the musculotendinous contributions to the capsule of the symphysis pubis. AJR Am J Roentgenol. 2007;188(5):W440–5.

    Article  PubMed  Google Scholar 

  3. Gamble JG, Simmons SC, Freedman M. The symphysis pubis. Anatomic and pathologic considerations. Clin Orthop Relat Res. 1986;203:261–72.

    PubMed  Google Scholar 

  4. Pick TP, Howden R, editors. Gray’s anatomy, descriptive and surgical, 15th ed. New York: Bounty Books; 1977. p. 178

    Google Scholar 

  5. Koulouris G. Imaging review of groin pain in elite athletes: an anatomic approach to imaging findings. AJR Am J Roentgenol. 2008;191(4):962–72.

    Article  PubMed  Google Scholar 

  6. Hiti CJ, Stevens KJ, Jamati MK, Garza D, Matheson GO. Athletic osteitis pubis. Sports Med. 2011;41(5):361–76.

    Article  PubMed  Google Scholar 

  7. Davis JA, Stringer MD, Woodley SJ. New insights into the proximal tendons of adductor longus, adductor brevis and gracilis. Br J Sports Med. 2012;46(12):871–6.

    Article  CAS  PubMed  Google Scholar 

  8. Palmer WE, Kuong SJ, Elmadbouh HM. MR imaging of myotendinous strain. AJR Am J Roentgenol. 1999;173(3):703–9.

    Article  CAS  PubMed  Google Scholar 

  9. Nguyen B, Brandser E, Rubin DA. Pains, strains, and fasciculations: lower extremity muscle disorders. Magn Reson Imaging Clin N Am. 2000;8(2):391–408.

    CAS  PubMed  Google Scholar 

  10. Tyler TF, Silvers HJ, Gerhardt MB, Nicholas SJ. Groin injuries in sports medicine. Sports Health. 2010;2(3):231–6.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Connell D, Ali K, Javid M, Bell P, Batt M, Kemp S. Sonography and MRI of rectus abdominis muscle strain in elite tennis players. AJR Am J Roentgenol. 2006;187(6):1457–61.

    Article  PubMed  Google Scholar 

  12. Gilmore J. Groin pain in the soccer athlete: fact, fiction, and treatment. Clin Sports Med. 1998;17(4):787–93. vii.

    Article  CAS  PubMed  Google Scholar 

  13. Vanhoenacker FM, Snoeckx A. Bone marrow edema in sports: general concepts. Eur J Radiol. 2007;62(1):6–15.

    Article  CAS  PubMed  Google Scholar 

  14. Verrall GM, Slavotinek JP, Fon GT, Barnes PG. Outcome of conservative management of athletic chronic groin injury diagnosed as pubic bone stress injury. Am J Sports Med. 2007;35(3):467–74.

    Article  PubMed  Google Scholar 

  15. Verrall GM, Henry L, Fazzalari NL, Slavotinek JP, Oakeshott RD. Bone biopsy of the parasymphyseal pubic bone region in athletes with chronic groin injury demonstrates new woven bone formation consistent with a diagnosis of pubic bone stress injury. Am J Sports Med. 2008;36(12):2425–31.

    Article  PubMed  Google Scholar 

  16. Albers SL, Spritzer CE, Garrett Jr WE, Meyers WC. MR findings in athletes with pubalgia. Skeletal Radiol. 2001;30(5):270–7.

    Article  CAS  PubMed  Google Scholar 

  17. Slavotinek JP, Verrall GM, Fon GT, Sage MR. Groin pain in footballers: the association between preseason clinical and pubic bone magnetic resonance imaging findings and athlete outcome. Am J Sports Med. 2005;33(6):894–9.

    Article  PubMed  Google Scholar 

  18. Zoga AC, Kavanagh EC, Omar IM, Morrison WB, Koulouris G, Lopez H, et al. Athletic pubalgia and the “sports hernia”: MR imaging findings. Radiology. 2008;247(3):797–807.

    Article  PubMed  Google Scholar 

  19. Robinson P, Barron DA, Parsons W, Grainger AJ, Schilders EM, O’Connor PJ. Adductor-related groin pain in athletes: correlation of MR imaging with clinical findings. Skeletal Radiol. 2004;33(8):451–7.

    Article  CAS  PubMed  Google Scholar 

  20. Meyers WC, McKechnie A, Philippon MJ, Horner MA, Zoga AC, Devon ON. Experience with “sports hernia” spanning two decades. Ann Surg. 2008;248(4):656–65.

    PubMed  Google Scholar 

  21. Brennan D, O’Connell MJ, Ryan M, Cunningham P, Taylor D, Cronin C, et al. Secondary cleft sign as a marker of injury in athletes with groin pain: MR image appearance and interpretation. Radiology. 2005;235(1):162–7.

    Article  PubMed  Google Scholar 

  22. Schilders E, Bismil Q, Robinson P, O’Connor PJ, Gibbon WW, Talbot JC. Adductor-related groin pain in competitive athletes. Role of adductor enthesis, magnetic resonance imaging, and entheseal pubic cleft injections. J Bone Joint Surg Am. 2007;89(10):2173–8.

    Article  PubMed  Google Scholar 

  23. Brown RA, Mascia A, Kinnear DG, Lacroix V, Feldman L, Mulder DS. An 18-year review of sports groin injuries in the elite hockey player: clinical presentation, new diagnostic imaging, treatment, and results. Clin J Sport Med. 2008;18(3):221–6.

    Article  PubMed  Google Scholar 

  24. Orchard JW, Read JW, Neophyton J, Garlick D. Groin pain associated with ultrasound finding of inguinal canal posterior wall deficiency in Australian rules footballers. Br J Sports Med. 1998;32(2):134–9.

    Article  CAS  PubMed  Google Scholar 

  25. Balconi G. US in pubalgia. J Ultrasound. 2011;14(3):157–66.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Kijowski R, Tuite MJ. Pediatric throwing injuries of the elbow. Semin Musculoskelet Radiol. 2010;14(4):419–29.

    Article  PubMed  Google Scholar 

  27. Radic R, Annear P. Use of pubic symphysis curettage for treatment-resistant osteitis pubis in athletes. Am J Sports Med. 2008;36(1):122–8.

    Article  PubMed  Google Scholar 

  28. Verrall GM, Slavotinek JP, Fon GT. Incidence of pubic bone marrow oedema in Australian rules football players: relation to groin pain. Br J Sports Med. 2001;35(1):28–33.

    Article  CAS  PubMed  Google Scholar 

  29. Fricker PA, Taunton JE, Ammann W. Osteitis pubis in athletes. Infection, inflammation or injury? Sports Med. 1991;12(4):266–79.

    Article  CAS  PubMed  Google Scholar 

  30. Cunningham PM, Brennan D, O’Connell M, MacMahon P, O’Neill P, Eustace S. Patterns of bone and soft-tissue injury at the symphysis pubis in soccer players: observations at MRI. AJR Am J Roentgenol. 2007;188(3):W291–6.

    Article  PubMed  Google Scholar 

  31. Major NM, Helms CA. Pelvic stress injuries: the relationship between osteitis pubis (symphysis pubis stress injury) and sacroiliac abnormalities in athletes. Skeletal Radiol. 1997;26(12):711–7.

    Article  CAS  PubMed  Google Scholar 

  32. Harris NH, Murray RO. Lesions of the symphysis in athletes. Br Med J. 1974;4(5938):211–4.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  33. Kunduracioglu B, Yilmaz C, Yorubulut M, Kudas S. Magnetic resonance findings of osteitis pubis. J Magn Reson Imaging. 2007;25(3):535–9.

    Article  PubMed  Google Scholar 

  34. Williams PR, Thomas DP, Downes EM. Osteitis pubis and instability of the pubic symphysis. When nonoperative measures fail. Am J Sports Med. 2000;28(3):350–5.

    CAS  PubMed  Google Scholar 

  35. O’Connell MJ, Powell T, McCaffrey NM, O’Connell D, Eustace SJ. Symphyseal cleft injection in the diagnosis and treatment of osteitis pubis in athletes. AJR Am J Roentgenol. 2002;179(4):955–9.

    Article  PubMed  Google Scholar 

  36. Holt MA, Keene JS, Graf BK, Helwig DC. Treatment of osteitis pubis in athletes. Results of corticosteroid injections. Am J Sports Med. 1995;23(5):601–6.

    Article  CAS  PubMed  Google Scholar 

  37. Lovell G, Galloway H, Hopkins W, Harvey A. Osteitis pubis and assessment of bone marrow edema at the pubic symphysis with MRI in an elite junior male soccer squad. Clin J Sport Med. 2006;16(2):117–22.

    Article  PubMed  Google Scholar 

  38. Paajanen H, Hermunen H, Karonen J. Pubic magnetic resonance imaging findings in surgically and conservatively treated athletes with osteitis pubis compared to asymptomatic athletes during heavy training. Am J Sports Med. 2008;36(1):117–21.

    Article  PubMed  Google Scholar 

  39. Zajick DC, Zoga AC, Omar IM, Meyers WC. Spectrum of MRI findings in clinical athletic pubalgia. Semin Musculoskelet Radiol. 2008;12(1):3–12.

    Article  PubMed  Google Scholar 

  40. Gibbon WW, Hession PR. Diseases of the pubis and pubic symphysis: MR imaging appearances. AJR Am J Roentgenol. 1997;169(3):849–53.

    Article  CAS  PubMed  Google Scholar 

  41. Hopp SJ, Culemann U, Kelm J, Pohlemann T, Pizanis A. Osteitis pubis and adductor tendinopathy in athletes: a novel arthroscopic pubic symphysis curettage and adductor reattachment. Arch Orthop Trauma Surg. 2013;133(7):1003–9.

    Article  PubMed  Google Scholar 

  42. Fon LJ, Spence RA. Sportsman’s hernia. Br J Surg. 2000;87(5):545–52.

    Article  CAS  PubMed  Google Scholar 

  43. Kiuru MJ, Pihlajamaki HK, Ahovuo JA. Fatigue stress injuries of the pelvic bones and proximal femur: evaluation with MR imaging. Eur Radiol. 2003;13(3):605–11.

    PubMed  Google Scholar 

  44. Hill PF, Chatterji S, Chambers D, Keeling JD. Stress fracture of the pubic ramus in female recruits. J Bone Joint Surg Br. 1996;78(3):383–6.

    CAS  PubMed  Google Scholar 

  45. Noakes TD, Smith JA, Lindenberg G, Wills CE. Pelvic stress fractures in long distance runners. Am J Sports Med. 1985;13(2):120–3.

    Article  CAS  PubMed  Google Scholar 

  46. Lee JK, Yao L. Stress fractures: MR imaging. Radiology. 1988;169(1):217–20.

    CAS  PubMed  Google Scholar 

  47. Shin AY, Morin WD, Gorman JD, Jones SB, Lapinsky AS. The superiority of magnetic resonance imaging in differentiating the cause of hip pain in endurance athletes. Am J Sports Med. 1996;24(2):168–76.

    Article  CAS  PubMed  Google Scholar 

  48. Bradshaw C, McCrory P, Bell S, Brukner P. Obturator nerve entrapment. A cause of groin pain in athletes. Am J Sports Med. 1997;25(3):402–8.

    Article  CAS  PubMed  Google Scholar 

  49. Hammoud S, Bedi A, Magennis E, Meyers WC, Kelly BT. High incidence of athletic pubalgia symptoms in professional athletes with symptomatic femoroacetabular impingement. Arthroscopy. 2012;28(10):1388–95.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA

    David A. Rubin

  2. Musculoskeletal Section, Mallinckrodt Institute of Radiology, 510 South Kingshighway, St. Louis, MO, 63110, USA

    David A. Rubin

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  1. David A. Rubin
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Correspondence to David A. Rubin .

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Editors and Affiliations

  1. Alfred R. Shands Professor of Orthopedic Surgery, Head Orthopedic Team Physician, Director, Sports Medicine Fellowship Program, University of Virginia School of Medicine, Charlottesville, Virginia, USA

    David R. Diduch

  2. Team Surgeon, St. Louis Blues, Professor of Surgery, Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, Missouri, USA

    L. Michael Brunt

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Rubin, D.A. (2014). Imaging of Athletic Groin Pain. In: Diduch, D., Brunt, L. (eds) Sports Hernia and Athletic Pubalgia. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-7421-1_8

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  • DOI: https://doi.org/10.1007/978-1-4899-7421-1_8

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  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4899-7420-4

  • Online ISBN: 978-1-4899-7421-1

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