Abstract
The painful groin is a challenging entity. It is a common problem in sports with incidence 5–18 % and is most prevalent in sports which involve kicking and sprinting with rapid changes of direction. The adductor longus is the most common pathology causing long-standing problems.
The complexity of groin anatomy, the similarity of symptoms for different pathologies that may or may not co-exist and the lack of consensus in terminology for the different groin entities may lead to a diagnostic dilemma with difficulty to recognise the precipitating disease, delays in diagnosis and treatment and potential career-ending for the athlete.
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References
Ekstrand J, Hagglund M, Walden M. Epidemiology of muscle injuries in professional football (soccer). Am J Sports Med. 2011;39:1226–32.
Kirkendall DT, Garrett Jr WE. Clinical perspectives regarding eccentric muscle injury. Clin Orthop Relat Res. 2002;403S:81–9.
Armfield DR, David Hyun-Min DK, Towers JD, Bradley JP, Robertson DD. Sports-related muscle injury in the lower extremity. Clin Sports Med. 2006;25:803–42.
Tuite DJ, Finegan PJ, Saliaris AP, Renstrom PA, Donne B, O’Brien M. Anatomy of the proximal musculotendinous junction of the adductor longus muscle. Knee Surg Sports Traumatol Arthrosc. 1998;6(2):134–7.
Strauss E, Campbell K, Bosco J. Analysis of the cross-sectional area of the adductor longus tendon: a descriptive anatomic study. Am J Sports Med. 2007;35:996–9.
Engebretsen A, Myklebust G, Holme I, et al. Prevention of injuries among male soccer players. A prospective, randomized intervention study targeting players with previous injuries or reduced function. Am J Sports Med. 2008;36:1052–60.
Engebretsen A, Myklebust G, Holme I, et al. Intrinsic risk factors for groin injuries among male soccer players: a prospective cohort study. Am J Sports Med. 2010;38:2051–7.
Tyler TF, Nicholas SJ, Campbell RJ, et al. The association of hip strength and flexibility with the incidence of adductor muscle strains in professional ice hockey players. Am J Sports Med. 2001;29:124–8.
Holmich P, Holmich LR, Bjerg AM. Clinical examination of athletes with groin pain: an intraobserver and interobserver reliability study. Br J Sports Med. 2004;38:446–51.
Dimitrakopoulou A, Schilders EMJ, Talbot JC, Bismil Q. Acute avulsion of the fibrocartilage origin of the adductor longus in professional soccer players: a report of two cases. Clin J Sport Med. 2008;18(2):167–9.
Martens M, Hansen L, Mulier JC. Adductor tendinitis and musculus rectus abdominis tendopathy. Am J Sports Med. 1987;15:353–6.
Robertson I, Curran C, McCaffrey N, et al. Adductor tenotomy in the management of groin pain in athletes. Int J Sports Med. 2011;32:45–8.
Schilders E, Dimitrakopoulou A, Cooke M, Bismil Q, Cooke C. Effectiveness of a selective partial adductor release for chronic adductor-related groin pain in professional athletes. Am J Sports Med. 2013;41(3):603–7.
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;33:451–7.
Holmich P, Uhrskou P, Ulnits L, et al. Effectiveness of active physical training as treatment for long-standing adductor related groin pain in athletes: randomized trial. Lancet. 1999;353:439–43.
Schilders E, Bismil Q, Robinson P, et al. 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.
Schilders E, Talbot JC, Robinson P, Dimitrakopoulou A, Gibbon WW, Bismil Q. Adductor-related groin pain in recreational athletes: role of adductor enthesis, magnetic resonance imaging, and entheseal pubic cleft injections. J Bone Joint Surg Am. 2009;91:2455–60.
Akermark C, Johansson C. Tenotomy of the adductor longus tendon in the treatment of chronic groin pain in athletes. Am J Sports Med. 1992;20:640–3.
Atkinson H, Parminder J, Falworth M, et al. Adductor tenotomy: its role in the management of sports-related chronic groin pain. Arch Orthop Trauma Surg. 2010;130:965–70.
Hasselman CT, Best T, Hughes C, Martinez S, Garrett W. An explanation for various rectus femoris strain injuries using previously undescribed muscle architecture. Am J Sports Med. 1995;23:493–9.
Mendiguchia J, Alentorn-Geli E, Idoate F, Myer G. Rectus femoris muscle injuries in football: a clinically relevant review of mechanisms of injury, risk factors and preventive strategies. Br J Sports Med. 2013;47(6):359–66.
Shu B, Safran MR. Hip instability: anatomic and clinical considerations of traumatic and atraumatic instability. Clin Sports Med. 2011;30:349–67.
Gamradt S, Brophy R, Barnes R, Warren R, Byrd T, Kelly B. Nonoperative treatment for proximal avulsion of the rectus femoris in professional American football. Am J Sports Med. 2009;37:1370–4.
Garcia V, Duhrkop D, Seijas R, Ares O, Cugat R. Surgical treatment of proximal ruptures of the rectus femoris in professional soccer players. Arch Orthop Trauma Surg. 2012;132(3):329–33.
Brophy R, Wright R, Powell J, et al. Injuries to kickers in American football: the National League experience. Am J Sports Med. 2010;38:1166–73.
Wittstein J, Klein S, Garrett WE. Chronic tears of the reflected head of the rectus femoris. Results of operative treatment. Am J Sports Med. 2011;39(9):1942–7.
Hughes IV C, Hasselman CT, Best TM, Martinez S, Garrett Jr WE. Incomplete, intrasubstance strain injuries of the rectus femoris muscle. Am J Sports Med. 1995;23(4):501–6.
Cross TM, Gibbs N, Houang MT, Cameron M. Acute quadriceps muscle strains: magnetic resonance imaging features and prognosis. Am J Sports Med. 2004;32(3):710–9.
Ouellette H, Thomas B, Nelson E, Torriani M. MR imaging of rectus femoris origin injuries. Skeletal Radiol. 2006;35(9):665–72.
Garrett WE. Muscle strain injuries. Am J Sports Med. 1996;24:S2–8.
Kellis E, Baltzopoulos V. Isokinetic eccentric exercise. Sports Med. 1995;19:202–22.
Gyftopoulos S, Rosenberg ZS, Schweitzer ME, et al. Normal anatomy and strains of the deep musculotendinous junction of the proximal rectus femoris: MRI features. AJR Am J Roentgenol. 2008;190:182–6.
Irmola T, Heikkila J, Orava S, Sarimo J. Total proximal tendon avulsion of the rectus femoris muscle. Scand J Med Sci Sports. 2007;17:378–82.
Witvrouw E, Danneels L, Asselman P, et al. Muscle flexibility as risk factor for developing muscle injuries in male professional soccer players. A prospective study. Am J Sports Med. 2003;31:41–6.
Fousekis K, Tsepis E, Poulmedis P, et al. Intrinsic risk factors of non-contact quadriceps and hamstring strains in soccer: a prospective study of 100 professional players. Br J Sports Med. 2011;45:709–14.
Dimitrakopoulou A, Schilders E, Bismil Q, Talbot JC, Kazakos K. An unusual case of enthesophyte formation following an adductor longus rupture in a high-level athlete. Knee Surg Sports Traumatol Arthrosc. 2010;18(5):691–3.
O’Brien M, Delaney M. The anatomy of the hip and groin. Sports Med Arthrosc Rev. 1997;5(4):252–67.
Conte SA, Thompson MM, Marks MA, Dines JS. Abdominal muscle strains in professional baseball: 1991-2010. Am J Sports Med. 2012;40(3):650–6.
Maquirriain J, Ghisi JP, Kokalj AM. Rectus abdominis muscle strains in tennis players. Br J Sports Med. 2007;41:842–8.
Atkins JM, Taylor JC, Kane SF. Acute and overuse injuries of the abdomen and groin in athletes. Curr Sports Med Rep. 2010;9(2):115–20.
Johnson R. Abdominal wall injuries: rectus abdominis strains, oblique strains, rectus sheath hematoma. Curr Sports Med Rep. 2006;5(2):99–103.
Biedert RM, Warnke K, Meyer S. Symphysis syndrome in athletes: surgical treatment for chronic lower abdominal, groin, and adductor pain in athletes. Clin J Sport Med. 2003;13(5):278–84.
Mandelbaum B, Mora SA. Osteitis pubis. Oper Tech Sports Med. 2005;13(1):62–7.
Beatty T. Osteitis pubis in athletes. Curr Sports Med Rep. 2012;11:96–8.
Mullens FE, Zoga AC, Morrison WB, et al. Review of MRI technique and imaging findings in athletic pubalgia and the “sports hernia”. Eur J Radiol. 2012;81:3780–92.
Zoga AC, Kavanagh EC, Omar IM, et al. Athletic pubalgia and the “sports hernia”: MR imaging findings. Radiology. 2008;247:797–807.
Omar IM, Zoga AC, Kavanagh EC, et al. Athletic pubalgia and “sports hernia”: optimal MR imaging technique and findings. Radiographics. 2008;28:1415–38.
Lovell G. 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.
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.
Martinoli C, Miguel-Perez M, Padua L, Gandolfo N, Zicca A, Tagliafico A. Imaging of neuropathies about the hip. Eur J Radiol. 2013;82(1):17–26.
Irshad K, Feldman LS, Lavoie C, Lacroix VJ, Mulder DS, Brown RA. Operative management of “hockey groin syndrome”: 12 years of experience in National Hockey League players. Surgery. 2001;130(4):759–64.
Holzheimer RG, Gresser U. Inguinal hernia vs. arthritis of the hip in sporting adolescent-case report and review of the literature. Eur J Med Res. 2007;12(7):314–9.
Cheatham SW, Kolber MJ, Salamh PA. Meralgia paresthetica: a review of the literature. Int J Sports Phys Ther. 2013;8(6):883–93.
Jacobs JM, Cameron KL, Bojescul JA. Lower extremity stress fractures in the military. Clin Sports Med. 2014;33(4):591–613.
Behrens SB, Deren ME, Matson A, Fadale PD, Monchik KO. Stress fractures of the pelvis and legs in athletes: a review. Sports Health. 2013;5(2):165–74.
Shin AY, Gillingham BL. Fatigue fractures of the femoral neck in athletes. J Am Acad Orthop Surg. 1997;5(6):293–302.
Iwamoto J, Takeda T. Stress fractures in athletes: review of 196 cases. J Orthop Sci. 2003;8(3):273–8.
Miller C, Major N, Toth A. Pelvic stress injuries in the athlete: management and prevention. Sports Med. 2003;33(13):1003–12.
Fredericson M, Jennings F, Beaulieu C, Matheson GO. Stress fractures in athletes. Top Magn Reson Imaging. 2006;17(5):309–25.
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Dimitrakopoulou, A., Schilders, E. (2017). The Painful Groin. In: McCarthy, J., Noble, P., Villar, R. (eds) Hip Joint Restoration. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-0694-5_30
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