Skip to main content

Review: imaging of groin pain in the athlete

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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18
Fig. 19
Fig. 20
Fig. 21
Fig. 22

References

  1. Kavanagh EC, Koulouris G, Ford S, McMahon P, Johnson C, Eustace SJ. MR imaging of groin pain in the athlete. Semin Musculoskelet Radiol. 2006;10:197–207.

    Article  PubMed  Google Scholar 

  2. Anderson K, Strickland SM, Warren R. Hip and groin injuries in athletes. Am J Sports Med. 2001;29:521–33.

    CAS  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  4. Gray H. (2000) Anatomy of the human body. Philadelphia: Lea & Febiger, 1918. Reviewed and re-edited by Lewis WH.

  5. Francis CC. The human pelvis. St. Louis: Mosby; 1952.

    Google Scholar 

  6. 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;188:440–5.

    Article  Google Scholar 

  7. Pentecost RL, Murray RA, Brindley HH. Fatigue, insufficiency, and pathological fractures. J Am Med Assoc. 1964;187:1001–4.

    CAS  Google Scholar 

  8. Markley KL. Stress fractures. Clin Sports Med. 1987;6:405–25.

    Google Scholar 

  9. Belkin SC. Stress fractures in athletes. Orthop Clin North Am. 1980;11:735–41.

    CAS  PubMed  Google Scholar 

  10. Jones BH, Harris JM, Vinh TN, Rubin C. Exercise-induced stress fractures and stress reactions of bone: epidemiology, etiology, and classification. Exerc Sport Sci Rev. 1989;17:379–422.

    CAS  PubMed  Google Scholar 

  11. Stanitski CL, McMaster JH, Scranton PE. On the nature of stress fractures. Am J Sports Med. 1978;6:391–6.

    Article  CAS  PubMed  Google Scholar 

  12. Matheson GO, Clement DB, McKenzie DC, Taunton JE, Lloyd-Smith DR, MacIntyre JG. Stress fractures in athletes. A study of 320 cases. Am J Sports Med. 1987;15:46–58.

    Article  CAS  PubMed  Google Scholar 

  13. Brudvig TJ, Gudger TD, Obermeyer L. Stress fractures in 295 trainees: a 1-year study of incidence as related to age sex, and race. Mil Med. 1983;148:666–7.

    CAS  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  15. Williams TR, Puckett ML, Denison G, Shin AY, Gorman JD. Acetabular stress fractures in military endurance athletes and recruits: incidence and MRI and scintigraphic findings. Skeletal Rad. 2003;31(5):277–281.

    Google Scholar 

  16. Pavlov H, Nelson TL, Warren RF, Torg JS, Burstein AH. Stress fractures of the pubic ramus. A report of twelve cases. J Bone Joint Surg Am. 1982;64:1020–5.

    CAS  PubMed  Google Scholar 

  17. Johansson C, Ekenman I, Törnvist H, Eriksson E. Stress fractures of the femoral neck in athletes. The consequence of a delay in diagnosis. Am J Sports Med. 1990;18:524–8.

    Article  CAS  PubMed  Google Scholar 

  18. Beer E. Periostitis of the symphysis and descending rami of the pubes following suprapubic operations. Int J Med Surg. 1924;37:2245.

    Google Scholar 

  19. Fanton SF. Osteitis pubis etiology and treatment. Paper presented at: Sports Medicine 1997: An NFL Perspective; 9–11 May 1997; San Francisco, CA.

  20. Spitz D, Newberg A. Imaging of stress fractures in the athlete. Radiol Clin N Am. 2002;40:313–31.

    Article  PubMed  Google Scholar 

  21. Sofka CM. Imaging of stress fractures. Clin Sports Med. 2006;25:53–62.

    Article  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  23. Kornaat PR, de Jonge MC, Maas M. Bone marrow edema-like signal in the athlete. Eur J Radiol. 2008;67:49–53.

    Article  PubMed  Google Scholar 

  24. Slocum KA, Gorman JD, Puckett ML, Jones SB. Resolution of abnormal MR signal intensity in patients with stress fractures of the femoral neck. AJR Am J Roentgenol. 1997;168:1295–9.

    CAS  PubMed  Google Scholar 

  25. Rupini HD, Holder LE, Espinola DA, et al. Three-phase radionucleotide bone imaging in sports medicine. Radiology. 1985;156:187–96.

    Google Scholar 

  26. Rodriguez C, Miguel A, Lima H, Heinrichs K. Osteitis pubis syndrome in the professional soccer athlete: a case report. J Athl Train. 2001;36:437–40.

    PubMed  Google Scholar 

  27. 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;35:28–33.

    Article  CAS  PubMed  Google Scholar 

  28. Robinson P, Barron DA, Parsons W, Schilders EM, Grainger AJ, O’Connor P. Adductor related groin pain in athletes. Correlation of MRI imaging with clinical findings. Skeletal Radiol. 2004;33:451–7.

    Article  CAS  PubMed  Google Scholar 

  29. 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;179:9559.

    Google Scholar 

  30. Holt MA, Keene JS, Graf BK, Helwig DC. Treatment of osteitis pubis in athletes: results of corticosteroid injections. Am J Sports Med. 1995;23:6017.

    Article  Google Scholar 

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

    Google Scholar 

  32. Grace JN, Sim FH, Shives TC, Coventry MB. Wedge resection of symphysis pubis for the treatment of osteitis pubis. J Bone Joint Surg Am. 1989;71:35864.

    Google Scholar 

  33. Maksymowych WP, Aaron SL, Russell AS. Treatment of refractory symphysitis pubis with intravenous pamidronate. J Rheumatol. 2001;28:2754–7.

    CAS  PubMed  Google Scholar 

  34. 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;235:162–7.

    Article  PubMed  Google Scholar 

  35. 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;89:2173–8.

    Article  PubMed  Google Scholar 

  36. Palmer WE, Kuong SJ, Elmdbouh HM. MR imaging of myotendinous strain. AJR Am J Roentgenol. 1999;173:703–9.

    CAS  PubMed  Google Scholar 

  37. Marcantonio DR, Cho GJ. Focus on muscle in orthopaedic MRI. Semin Musculoskelet Radiol. 2000;4:421–34.

    Article  CAS  PubMed  Google Scholar 

  38. El-Khoury GY, Brandser EA, Kathol MH, Tearse DS, Callaghan JJ. Imaging of muscle injuries. Skeletal Radiol. 1996;25:3–11.

    Article  CAS  PubMed  Google Scholar 

  39. Fleckenstein JL, Weatherall PT, Parkey RW, Payne JA, Peshock RM. Sports-related muscle injuries: evaluation with MR imaging. Radiology. 1989;172:793–8.

    CAS  PubMed  Google Scholar 

  40. Gerlach UJ, Lierse W. Functional construction of the superficial and deep fascia system of the lower limb in man. Acta Anat. 1990;139:11–25.

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  Google Scholar 

  42. House CV, Ali KE, Bradshaw C, Connell DA. CT-guided obturator nerve block via the posterior approach. Skeletal Radiol. 2006;35:227–32.

    Article  CAS  PubMed  Google Scholar 

  43. Lehman RC. Thoracoabdominal musculoskeletal injuries in racquet sports. Clin Sports Med. 1988;7:267–76.

    CAS  PubMed  Google Scholar 

  44. 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;187:1457–61.

    Article  PubMed  Google Scholar 

  45. Gilmore OLA. Gilmore’s groin: ten years experience of groin disruption. Sports Med Soft Tissue Trauma. 1991;3:5–7.

    Google Scholar 

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

    Article  PubMed  Google Scholar 

  47. Kumar A, Doran J, Batt ME, Nguyen-Van-Tam JS, Beckingham IJ. Results of inguinal canal repair in athletes with sports hernia. J R Coll Surg Edinb. 2002;47:561–5.

    CAS  PubMed  Google Scholar 

  48. 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;28:1415–38.

    Article  PubMed  Google Scholar 

  49. Fon LJ, Spence AJ. Sportsman’s hernia. Br J Surg. 2000;87:545–52.

    Article  CAS  PubMed  Google Scholar 

  50. Gullmo A. Herniography. The diagnosis of a hernia in the groin and incompetence of the pouch of Douglas and pelvic floor. Acta Radiol Suppl. 1980;361:1–76.

    CAS  PubMed  Google Scholar 

  51. Gilmore J. Groin pain in the soccer athlete: fact fiction and treatment. Clin Sports Med. 1998;17:787–93.

    Article  CAS  PubMed  Google Scholar 

  52. Malycha P, Lovell G. Inguinal surgery in athletes with chronic groin pain: the ‘sportsman’s hernia’. Aust J Sci Med Sport. 1992;62:123–5.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Andrew W. Clarke.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Davies, A.G., Clarke, A.W., Gilmore, J. et al. Review: imaging of groin pain in the athlete. Skeletal Radiol 39, 629–644 (2010). https://doi.org/10.1007/s00256-009-0768-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-009-0768-9

Keywords

  • Chronic groin pain
  • Groin injury
  • Sports hernia
  • Athletic pubalgia
  • Adductor enthesopathy
  • Osteitis pubis
  • Review