Imaging review of groin pain in elite athletes: An anatomic approach to imaging findings

American Journal of Roentgenology

Volumn 191, Issue 4, 2008, Pages 962-972

  Koulouris, George ^a  

^a Victoria House Medical Imaging   (Australia)

Author keywords

Adductor longus; Athletes; Groin; Hernia; MRI; Osteitis pubis; Rectus abdominis

Indexed keywords

ANATOMY; ATHLETE; BIOMECHANICS; COMPUTER ASSISTED TOMOGRAPHY; DIAGNOSTIC PROCEDURE; DIFFERENTIAL DIAGNOSIS; IMAGING; INGUINAL HERNIA; MUSCLE DISEASE; NUCLEAR MAGNETIC RESONANCE IMAGING; OSTEITIS; PAIN; PRIORITY JOURNAL; RECTUS ABDOMINIS MUSCLE; REVIEW; SPORT INJURY;

ATHLETIC INJURIES; CONTRAST MEDIA; DIAGNOSIS, DIFFERENTIAL; GROIN; HUMANS; MAGNETIC RESONANCE IMAGING; PAIN; TOMOGRAPHY, X-RAY COMPUTED;

EID: 53249092260     PISSN: 0361803X     EISSN: None     Source Type: Journal    
DOI: 10.2214/AJR.07.3410     Document Type: Review

References (87)

1. Gilmore J. Groin pain in the soccer athlete: fact, fiction, and treatment. Clin Sports Med 1998; 17:787-793
2. Syme G, Wilson J, Mackenzie K, Macleod D. Groin pain in athletes. Lancet 1999; 353:1444
3. Smodlaka VN. Groin pain in soccer players. Phys Sports Med 1980; 8:57-61
4. Rizk NN. A new description of the anterior abdominal wall in man and mammals. J Anat 1980; 131(Pt 3):373-385
5. 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; 6:134-137
6. Rosenklint A, Andersen RB. Tenosteochondrosis of the pubis. Acta Rheumatol Scand 1969; 15:262-270
7. Adams RJ, Chandler FA. Osteitis pubis of traumatic etiology. J Bone Joint Surg Am 1953; 35-A:685-696
8. Robinson P, Salehi F, Grainger A, et al. Cadaveric and MRI study of the musculotendinous contributions to the capsule of the symphysis pubis. AJR 2007; 188:1306; [web]W440-W445
9. Ippolito E, Postacchini F. Rupture and disinsertion of the proximal attachment of the adductor longus tendon: case report with histochemical and ultrastructural study. Ital J Orthop Traumatol 1981; 7:79-85
10. Gamble JG, Simmons SC, Freedman M. The symphysis pubis: anatomic and pathologic considerations. Clin Orthop Relat Res 1983; 203:261-272
11. Snijders CJ, Vleeming A, Stoeckart R. Transfer of lumbosacral load to iliac bones and legs. Part I: Biomechanics of self-bracing of the sacroiliac joints and its significance for treatment and exercise. Clin Biomech 1993; 8:285-294
12. Cowan SM, Schache AG, Brukner P, et al. Delayed onset of transversus abdominis in long-standing groin pain. Med Sci Sports Exerc 2004; 36:2040-2045
13. Condon RE. Reassessment of groin anatomy during the evolution of preperitoneal hernia repair. Am J Surg 1996; 172:5-8
14. Gibbon WW. Groin pain in athletes. Lancet 1999; 353:1444-1445
15. Walheim GG, Selvik G. Mobility of the pubic symphysis: in vivo measurements with an electromechanic method and a roentgen stereophotogrammetric method. Clin Orthop Relat Res 1984; 191:129-135
16. Renstrom P, Peterson L. Groin injuries in athletes. Br J Sports Med 1980; 14:30-36
17. Karlsson J, Sward L, Kalebo P, Thomee R. Chronic groin injuries in athletes: recommendations for treatment and rehabilitation. Sports Med 1994; 17:141-148
18. Attarian DE. Isolated acute hip adductor brevis strain. J South Orthop Assoc 2000; 9:213-215
19. Riedeberger J, Luschnitz E, Bauchspiess B. The pubic bone-adductor- syndrome in football players [in German]. Zentralbl Chir 1967; 92:2656-2660
20. Morrenhof JW, Fievez AWFM. The adductor syndrome and the functional anatomy of the adductors. Acta Orthop Scand 1985; 56:542
21. Wiley JJ. Traumatic osteitis pubis: the gracilis syndrome. Am J Sports Med 1983; 11:360-363
22. Emery CA, Meeuwisse WH. Risk factors for groin injuries in hockey. Med Sci Sports Exerc 2001; 33:1423-1433
23. Martens MA, Hansen L, Mulier JC. Adductor tendinitis and musculus rectus abdominis tendopathy. Am J Sports Med 1987; 15:353-356
24. Cunningham PM, Brenna 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 2007; 188:864; [web]W291-W296
25. Schneider R, Kaye J, Ghelman B. Adductor avulsive injuries near the symphysis pubis. Radiology 1976; 120:567-569
26. Balduini FC. Abdominal and groin injuries in tennis. Clin Sports Med 1988; 7:349-357
27. Connell DA, Ali KE, Javid M, Bell P, Batt M, Kemp S. Sonography and MRI of rectus abdominis muscle strain in elite tennis players. AJR 2006; 187:1457-1461
28. Kalebo P, Karlsson J, Sward L, Peterson L. Ultrasonography of chronic tendon injuries in the groin. Am J Sports Med 1992; 20:634-639
29. Goh LA, Chhem KR, Wang SC, Tho KS. Ultrasonographic features of an adductor longus tear: case report. Can Assoc Radiol J 2001; 52:252-254
30. Ashby EC. Chronic obscure groin pain is commonly caused by enthesopathy: 'tennis elbow' of the groin. Br J Surg 1994; 81:1632-1634
31. Connell DA, Ali KE, Ahmad M, Lambert S, Corbett S, Curtis M. Ultrasound-guided autologous blood injection for tennis elbow. Skeletal Radiol 2006; 35:371-377
32. Fujiwara Y, Sato Y, Kitayama M, Shibata Y, Komatsu T, Hirota K. Obturator nerve block using ultrasound guidance. Anesth Analg 2007; 105:888-889
33. House CV, Ali KE, Bradshaw C, Connell DA. CT-guided obturator nerve root block via the posterior approach. Skeletal Radiol 2006; 35:227-232
34. 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; 33:451-457
35. Legeu MB, Rochet WL. Les cellulites perivescicales et pelviennes après certaines cystostomies ou prostatectomies sus-pubiennes. J Urol Med Chir 1923; 15:1-11
36. Grace JN, Sim FH, Shives TC, Coventry MB. Wedge resection of the symphysis pubis for the treatment of osteitis pubis. J Bone Joint Surg Am 1989; 71:358-364
37. McCarthy B, Dorfman HD. Pubic osteolysis: a benign lesion of the pelvis closely mimicking a malignant neoplasm. Clin Orthop Relat Res 1990; (251):300-307
38. Levine AH, Pais MJ, Schwartz EE. Posttraumatic osteolysis of the distal clavicle with emphasis on early radiographic changes. AJR 1976; 127:781-784
39. Verrall GM, Hamilton IA, Slavotinek JP, et al. Hip joint range of motion reduction in sports-related chronic groin injury diagnosed as pubic bone stress injury. J Sci Med Sport 2005; 8:77-84
40. Sequeira W. Diseases of the pubic symphysis. Semin Arthritis Rheum 1986; 16:11-21
41. Brennan D, O'Connell MJ, Ryan M, et al. Secondary cleft sign as a marker of injury in athletes with groin pain: MR image appearance and interpretation. Radiology 2005; 235:162-167
42. Morelli V, Espinoza L. Groin injuries and groin pain in athletes: part 2. Prim Care 2005; 32: 185-200
43. 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
44. Verrall GM, Slavotinek JP, Barnes PG, Fon GT. Description of pain provocation tests used for the diagnosis of sports-related chronic groin pain: relationship of tests to define clinical (pain and tenderness) and MRI (pubic bone marrow oedema) criteria. Scand J Med Sci Sports 2005; 15:36-42
45. 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; 33:894-899
46. Harris NH, Murray RO. Lesions of the symphysis in athletes. BMJ 1974; 4:211-214
47. Goergen TG, Resnick D, Riley RR. Post-traumatic abnormalities of the pubic bone simulating malignancy. Radiology 1978; 126:85-86
48. Hall FM, Goldberg RP, Kasdon EJ, Glick H. Posttraumatic osteolysis of the pubic bone simulating a malignant lesion. J Bone Joint Surg Am 1984; 66:121-126
49. McGuigan LE, Edmonds JP, Painter DM. Pubic osteolysis. J Bone Joint Surg Am 1984; 66:127-129
50. Ekberg O, Kesek P, Besjakov J. Herniography and magnetic resonance imaging in athletes with chronic groin pain. Sports Med Arthroscop Rev 1997; 5:274-279
51. 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 man soccer squad. Clin J Sport Med 2006; 16:117-122
52. Briggs RC, Kolbjornsen PH, Southall RC. Osteitis pubis, Tc-99m MDP and professional hockey players. Clin Nucl Med 1992; 17:861-863
53. 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 2002; 179:955-959
54. Koch RA, Jackson DW. Pubic symphysitis in runners: a report of two cases. Am J Sports Med 1981; 9:62-63
55. Holt MA, Keene JS, Graf BK, Helwig DC. Treatment of osteitis pubis in athletes: results of corticosteroid injections. Am J Sports Med 1995; 23:601-606
56. Maksymowych WP, Aaron SL, Russell AS. Treatment of refractory symphysitis pubis with intravenous pamidronate. J Rheumatol 2001; 28:2754-2757
57. Cohen RH, Turkenburg JL, van Dalen A. Herniography in 79 patients with unexplained pain in the groin: a retrospective study. Eur J Radiol 1990; 11:184-187
58. Smedberg SG, Broome AE, Elmer O, Gullmo A. Herniography in the diagnosis of obscure groin pain. Acta Chir Scand 1985; 151:663-667
59. Shadbolt CL, Heinze SB, Dietrich RB. Imaging of groin masses: inguinal anatomy and pathologic conditions revisited. RadioGraphics 200l; 21[spec no]:S261-S271
60. Jamadar DA, Jacobson JA, Morag Y, et al. Sonography of inguinal region hernias. AJR 2006; 187:185-190
61. Smedberg SG, Broome AE, Gullmo A, Roos H. Herniography in athletes with groin pain. Am J Surg 1985; 149:378-382
62. Urquhart DA, Packer GJ, McLatchie GR. Return to sport and patient satisfaction levels after surgical treatment for groin disruption. Sports Exercise and Injury 1996; 2:37-42
63. Taylor DC, Meyers WC, Moylan JA, Lohnes J, Bassett FH, Garrett WE Jr. Abdominal musculature abnormalities as a cause of groin pain in athletes: inguinal hernias and pubalgia. Am J Sports Med 1991; 19:239-242
64. Hackney RG. The sports hernia: a cause of chronic groin pain. Br J Sports Med 1993; 27:58-62
65. Malycha P, Lovell G. Inguinal surgery in athletes with chronic groin pain: the 'sportsman's' hernia. Aust N Z J Surg 1992; 62:123-125
66. Lovell G. The diagnosis of chronic groin pain in athletes: a review of 189 cases. Aust J Sci Med Sport 1995; 27:76-79
67. 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; 13:278-284
68. MacLeod DA, Gibbon WW. The sportsman's groin. Br J Surg 1999; 86:849-850
69. Gilmore OJA. Gilmore's groin: a ten years experience of groin disruption. Sports Med Soft Tissue Trauma 1991; 3:5-7
70. 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; 47:561-565
71. MacLeod DA. The sportsman's groin (commentary). Br J Surg 1999; 86:1478
72. Ingoldby CJ. Laparoscopic and conventional repair of groin disruption in sportsmen. Br J Surg 1997; 84:213-215
73. Evans DS. Hunterian lecture. Laparoscopic transabdominal pre-peritoneal (transabdominal preperitoneal) repair of groin hernia: one surgeon's experience of a developing technique. Ann R Coll Surg Engl 2002; 84:393-398
74. Schuricht A, Haut E, Wetzler M. Surgical options in the treatment of sports hernia. Operative Techniques in Sports Medicine 2002; 10:224-227
75. Meyers WC, Foley DP, Garrett WE, Lohnes JH, Mandlebaum BR. Management of severe lower abdominal or inguinal pain in high-performance athletes. PAIN (Performing Athletes with Abdominal or Inguinal Neuromuscular Pain Study Group). Am J Sports Med 2000; 28:2-8
76. Diaco JF, Diaco DS, Lockhart L. Sports hernia. Operative Techniques in Sports Medicine 2005; 13:68-70
77. Genitsaris M, Goulimaris I, Sikas N. Laparoscopic repair of groin pain in athletes. Am J Sports Med 2004; 32:1238-1242
78. 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; 130:759-764
79. Ziprin P, Williams P, Foster ME. External oblique aponeurosis nerve entrapment as a cause of groin pain in the athlete. Br J Surg 1999; 86:566-568
80. Lovell G, Malycha P, Pieterse S. Biopsy of the conjoint tendon in athletes with chronic groin pain. Aus J Sci Med Sport 1990; 22:102-103
81. Polglase AL, Frydman GM, Farmer KC. Inguinal surgery for debilitating chronic groin pain in athletes. Med J Aust 1991; 155:674-677
82. 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; 32:134-139
83. Albers SL, Spritzer CE, Garrett WE Jr, Meyers WC. MR findings in athletes with pubalgia. Skeletal Radiol 2001; 30:270-277
84. Bass CJ, Connell DA. Sonographic findings of tensor fascia lata tendinopathy: another cause of anterior groin pain. Skeletal Radiol 2002; 31:143-148
85. Harvey G, Bell S. Obturator neuropathy: an anatomic perspective. Clin Orthop Relat Res 1999; 363:203-211
86. Akita K, Niga S, Yamato Y, Muneta T, Sato T. Anatomic basis of chronic groin pain with special reference to sports hernia. Surg Radiol Anat 1999; 21:1-5
87. Bradshaw C, McCrory P. Obturator nerve entrapment. Clin J Sport Med 1997; 7:217-219