Pelvis, Hip and Groin

  • Wayne Gibbon
  • Ernest Schilders
Part of the Medical Radiology book series (MEDRAD)

15.14 Conclusion

Medical imaging has an extremely valuable role in the differentiation between the wide range of potential causes of hip and groin pain in athletes. Without such differentiation effective treatment is difficult to achieve especially where considering overuse injuries which may even be exacerbated by treatment based on diagnostic inaccuracy.

Understanding the anatomy of the anterior pubic soft tissues allows correlation with MR imaging pathoanatomical appearances and therefore a better understanding of the pathomechanism of groin pain in athletes on which to base subsequent treatment.

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References

  1. Ackerman N, Spencer CP (1992) What is your diagnosis? Prepubic tendon injury, with avulsion fracture of the left pubis. J Am Vet Med Assoc 200(5):721–722PubMedGoogle Scholar
  2. Adams RJ, Chandler FA (1953) Osteitis pubis of traumatic etiology. J Bone Joint Surg (Am) 35(3):685–696PubMedGoogle Scholar
  3. Akermark C, Johansson C (1992) Tenotomy of the adductor longus tendon in the treatment of chronic groin pain in athletes. Am J Sports Med 20:640–643PubMedGoogle Scholar
  4. Akita K, Niga S, Yamato Y et al. (1999) Anatomic basis of chronic groin pain with special reference to sports hernia. Surg Radiol Anat 21(1):1–5PubMedGoogle Scholar
  5. Albers SL, Spritzer CE, Garrett WE Jr et al. (2001) MR findings in athletes with pubalgia. Skeletal Radiol 30(5):270–277PubMedCrossRefGoogle Scholar
  6. Albert M (1983) Descriptive Three Year Data Study of Outdoor and Indoor Professional Soccer Injuries. Athletic Train; 18:218–220Google Scholar
  7. Ashby EC (1994) Chronic obscure groin pain is commonly caused by enthesopathy-“tennis elbow” of the groin. Br J Surg 81:1632–1634PubMedGoogle Scholar
  8. Bouza E, Winston DJ, Hewitt WL (1978) Infectious osteitis pubis. Urology 12:663–669PubMedCrossRefGoogle Scholar
  9. Bradshaw C, McCrory P, Bell S et al. (1997) Obturator nerve entrapment. A cause of groin pain in athletes. Am J Sports Med 25(3):402–408PubMedGoogle Scholar
  10. Breitenfelder J, Huke B, Wolf N (1975) The problem of stress of the symphysis following hip arthrodesis (German). Archiv Orthopad Unfall-Chirurgie 81(2):119–124CrossRefGoogle Scholar
  11. Budinoff LC, Tague RG (1990). Anatomical and developmental bases for the ventral arc of the human pubis. Am J Phys Anthropol 82(1):73–79PubMedCrossRefGoogle Scholar
  12. Carnevale V (1954) La Denominada ‘Inguiocruralgia Traumatic de los Jugadores de Futbol’. Prensa Med Argent 41(5):355–357PubMedGoogle Scholar
  13. Casey D, Mirra J, Staple TW (1984) Parasymphyseal insufficiency fractures of the os pubis. Am J Roentgenol 142:581–586Google Scholar
  14. Cochrane GM (1971) Osteitis pubis in athletes. Br J Sports Med 5:233–235Google Scholar
  15. Dalstra M, Huiskes R, Odgaards A et al. (1993) Mechanical and textural properties of pelvic trabecular bone. J Biomech 26:523–535PubMedCrossRefGoogle Scholar
  16. Ekberg O, Persson NH, Abrahamsson PA et al. (1988) Longstanding groin pain in athletes. A multidisciplinary approach. Sports Med 6:56–61PubMedGoogle Scholar
  17. Ekstrand J, Gillquist J (1983) The avoidability of soccer injuries. Int J Sports Med 4:124–128PubMedGoogle Scholar
  18. Evans TW, Eveley RS, Morcos SK (1985) Asymptomatic osteomyelitis of the symphysis pubis. Postgrad Med J 61:267–268PubMedGoogle Scholar
  19. Fink-Bennett DM, Benson MT (1984) Unusual exercise related stress fractures — two case reports. Clin Nucl Med 9:430–434PubMedCrossRefGoogle Scholar
  20. Fredberg U, Kissmeyer-Nielsen P (1996) The sportsman’s hernia-fact or fiction? Scand J Med Sci Sports 6:201–204PubMedCrossRefGoogle Scholar
  21. Fricker PA, Taunton JE, Ammann W (1991) Osteitis pubis in athletes. Infection, inflammation or injury? Sports Med 12(4):266–279PubMedGoogle Scholar
  22. Gibbon WW (1998) Are Achilles tendon ruptures ever spontaneous? Br J Sports Med 32(3):266Google Scholar
  23. Gibbon WW, Cooper JR, Radcliffe GS (1999) Sonographic incidence of tendon microtears in athletes with chronic Achilles tendinosis. Br J Sports Med 33(2):129–130PubMedGoogle Scholar
  24. Gibbon WW, Cooper JR, Radcliffe GS (2000) Distribution of sonographically detected tendon abnormalities in patients with a clinical diagnosis of chronic Achilles tendinosis. J Clin Ultrasound 28(2):61–66PubMedCrossRefGoogle Scholar
  25. Gilmore OJA (1993) “Gilmore’s groin”: a previously unsolved problem in sportsmen. In: Mcleod DA, Maughan RJ, Williams C, Madeley CR, Sharp JMC, Nutton RW et al. (eds) Intermittent high intensity exercise; preparation, stresses and damage limitation. Chapman and Hall, London, pp 477–486Google Scholar
  26. Goergen TG, Resnick D, Riley RR (1978) Post-traumatic abnormalities of the pubic bone simulating malignancy. Radiology 126(1):85–87PubMedGoogle Scholar
  27. Gregory WK (1950) The anatomy of the gorilla; Henry Cushior Memorial Volume. Gregory WK (ed) New York, Columbia University Press, pp 150–151Google Scholar
  28. Hackney RG (1993) The sports hernia: a cause of chronic groin pain. Br J Sports Med 27:58–62PubMedGoogle Scholar
  29. Harris NH, Murray RO (1974) Lesions of the symphysis in athletes. Br Med J 4:211–214PubMedGoogle Scholar
  30. Heldrich F, Harris V (1979) Osteomyelitis of the pubis. Acta Paediatr Scand 68:39–41PubMedGoogle Scholar
  31. Holmich P, Uhrskou P, Ulnits L et al. (1999) Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: randomised trial. Lancet 6;353:439–443CrossRefGoogle Scholar
  32. Holt MA, Keene JS, Graf BK et al. (1995) Treatment of osteitis pubis in athletes. Results of corticosteroid injections. Am J Sports Med 23(5):601–606PubMedGoogle Scholar
  33. Hoon JR (1959) Adductor muscle injuries in bowlers. JAMA 171:2087–2089PubMedGoogle Scholar
  34. Hornof Z, Napravnik C (1969) Analysis of various accident rate factors in ice hockey. Med Sci Sports 5:283–286Google Scholar
  35. Irshad K, Feldman LS, Lavoie C et al. (2001) Operative management of “hockey groin syndrome”: 12 years of experience in National Hockey League players. Surgery 130(4):759–764PubMedCrossRefGoogle Scholar
  36. Jajic Z, Jajic I (1998) Condensing osteitis of the pubic bone. Reumatizam 46(1):51–53PubMedGoogle Scholar
  37. Kassarjian A, Yoon LS, Belzile E et al. (2005) Triad of MR arthrographic findings in patients with cam-type femoro-acetabular impingement. Radiology 236:588–592PubMedGoogle Scholar
  38. Keller CS, Noyes FR, Buncher CR (1987) The medical aspects of soccer injury epidemiology. Am J Sports Med 15(3):105–112Google Scholar
  39. Koch RA, Jackson DW (1981) Pubic symphysitis in runners-a report of two cases. Am J Sports Med 8(1):62–63Google Scholar
  40. Lebrun C, Vanhoenacker FM, Willemen D (2005) Anterior femoro-acetabular impingement of the CAM type. Radiological documents (2):15Google Scholar
  41. Lee CH, Dellon AL (2000) Surgical, anagement of groin pain of neural origin. J Am Coll Surg 191(2):137–142PubMedCrossRefGoogle Scholar
  42. Leno C, Combarros O, Polo JM et al. (1984) Bilateral obturator neuralgia secondary to osteitis of the pubis. Arch Neurobiol (Madr) 47(6):347–352Google Scholar
  43. Losada A, Saldias E (1968) Osteopatia dinamica del pubis. Revista Med 96:110–113Google Scholar
  44. Lovell G (1995) The diagnosis of chronic groin pain in athletes: a review of 189 cases. Aust J Sci Med Sport 27(3):76–79PubMedGoogle Scholar
  45. Marsden AJ (1962) Inguinal hernia: a three year review of two thousand cases. Br J Surg 49:384–394PubMedGoogle Scholar
  46. Martens MA, Hansen L, Mulier JC (1987) Adductor tendinitis and musculus rectus abdominis tendopathy. Am J Sports Med 15:353–356PubMedGoogle Scholar
  47. McGonagle D, Gibbon W, O’Connor P et al. (1998) Characteristic magnetic resonance imaging entheseal changes of knee synovitis in spondylarthropathy. Arthritis Rheum 41(4):694–700PubMedCrossRefGoogle Scholar
  48. Mitchell B, McCrory P, Brukner P et al. (2003) Hip joint pathology: clinical presentation and correlation between magnetic resonance arthrography, ultrasound, and arthroscopic findings in 25 consecutive cases. Clin J Sport Med 13(3):152–156PubMedCrossRefGoogle Scholar
  49. Modic MT, Steinberg PM, Ross JS et al. (1988) Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 166(1):193–199PubMedGoogle Scholar
  50. Morcuende JA, Arauz S, Weinstein SL (2000) Stress fracture of the hip and pubic rami after fusion to the sacrum in an adult with scoliosis: a case report. Iowa Orthop J 20:79–84PubMedGoogle Scholar
  51. Moretz A, Rashkin A, Grana WA (1978) Oklahoma high school football injury study: a preliminary report. J Okla State Med Assoc 71:85–86PubMedGoogle Scholar
  52. Nicholas JJ, Haidet E, Helfrich D et al. (1989) Groin and hip pain due to fractures at or near the pubic symphysis. Arch Phys Med Rehabil 70(9):696–698PubMedGoogle Scholar
  53. Nielsen AB, Yde J (1989) Epidemiology and traumatology of injuries in soccer. Am J Sports Med 17(6):803–807PubMedGoogle Scholar
  54. Numaguchi Y (1971) Osteitis condensans ilii, including its resolution. Radiology 98:1PubMedGoogle Scholar
  55. Ogden JA (1980). Chondro-osseous development and growth. In: Urist MR (ed) Fundamental and clinical bone physiology. JB Lippincott Company, Philadelphia, pp 108–171Google Scholar
  56. Orava S, Puranen J, Ala-Ketola L (1978). Stress fractures caused by physical exercise. Acta Orthop Scand 49:19–27PubMedCrossRefGoogle Scholar
  57. Patterson FP, Yovanovich R (1975) Pubic osteomyelitis and septic arthritis of the symphysis pubis. In: Proceedings of the Canadian Orthopaedic Association. J Bone Joint Surg (Br) 57(4):531–532Google Scholar
  58. Pierson EL (1929) Osteochondritis of the symphysis pubis. Surg Gynecol Obstet 49:834–838Google Scholar
  59. Reideberger Von J, Luschnitz E, Bauchspeiss (1967) The pubic adductor syndrome in footballers. Zentralblatt Chirugie 92:2655–2657Google Scholar
  60. Rosenklint A, Anderson RB (1969) Tenosteochondrosis of the pubis. Acta Rheum Scand 15:262–270PubMedGoogle Scholar
  61. Rosenthal RE, Spickard WA, Markham RD et al. (1982) Osteomyelitis of the symphysis pubis: a separate disease from osteitis pubis. J Bone Joint Surg (Am) 64(1):123–128PubMedGoogle Scholar
  62. Saw T, Villar R (2004) Footballer’s hip: a report of six cases. J Bone Joint Surg (Br) 86(5):655–658CrossRefGoogle Scholar
  63. Schneider PG (1963) Das Grazilissyndrom. Z Orthop 93:43–46Google Scholar
  64. Seward H, Orchard J, Hazard H, Collinson D et al. (1993) Football injuries in Australia at the elite level. Med J Aust 159:298–301PubMedGoogle Scholar
  65. Sexton DJ, Keskestad L, Lambeth WR et al. (1993) Postoperative pubic osteomyelitis misdiagnosed as osteitis pubis: report of four cases and review. Clin Infect Dis 17(4):695–700PubMedGoogle Scholar
  66. Spinelli A (1932) Nuova Malattia Sportive: La Pubialgia Degli Schernitori. Ortopedia E Trauma Apparato Motore 4:111–127Google Scholar
  67. FIFA (1992) Statistics on the 186 Affiliated National Associations of FIFA, FIFA, Zurich, SwitzerlandGoogle Scholar
  68. Sturesson B, Selvik G, Uden A (1989) Movements of the sacroiliac joints. A Roentgen stereophotogrammetric analysis. Spine 14(2):162–165PubMedCrossRefGoogle Scholar
  69. Tan AL, Marzo-Ortega H, O’Connor P et al. (2004) Efficacy of anakinra in active ankylosing spondylitis: a clinical and magnetic resonance imaging study. Ann Rheum Dis 63(9):1041–1045PubMedCrossRefGoogle Scholar
  70. Walheim GG, Selvik G (1984) Mobility of the pubic symphysis-in vivo measurements with an electromechanic method and a Roentgen stereophotogrammetric method. Clin Orthop 191:129–135PubMedGoogle Scholar
  71. Weaver CJ, Major NM, Garrett WE et al. (2002) Femoral head osteochondral lesions in painful hips of athletes: MR imaging findings. Am J Roentgenol 178(4):973–977Google Scholar
  72. Wiley JJ (1983) Traumatic osteitis pubis: the Gracilis syndrome. Am J Sports Med 11(5):360–363PubMedGoogle Scholar
  73. Williams JGP (1978) Limitation of hip joint movement as a factor of traumatic osteitis pubis. Br J Sports Med 12(3):129–133PubMedCrossRefGoogle Scholar
  74. Ziprin P, Williams P, Foster ME (1999) External oblique aponeurosis nerve entrapment as a cause of groin pain in the athlete. Br J Surg 86(4):566–568PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2007

Authors and Affiliations

  • Wayne Gibbon
    • 1
  • Ernest Schilders
    • 1
  1. 1.St. Lucia, BrisbaneAustralia

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