Imaging in the Assessment and Management of Athletic Pubalgia

ABSTRACT

This article reviews the clinical, anatomical, and biomechanical basis of pubalgia and relates it to the potential imaging findings and subsequent management. Although the magnetic resonance imaging features typically seen in symptomatic athletes are emphasized, this condition remains a complex clinical problem, and treatment addressing the functional rehabilitation of the entire region is highlighted.

KEYWORDS

Athletic injury - pubalgia - MRI - muscle injury - tendon injury - ultrasound

REFERENCES

• 1 Lynch S A, Renström P A. Groin injuries in sport: treatment strategies.  Sports Med. 1999;  28(2) 137-144
• 2 Fredberg U, Kissmeyer-Nielsen P. The sportsman's hernia—fact or fiction?.  Scand J Med Sci Sports. 1996;  6(4) 201-204
• 3 Hölmich P. Long-standing groin pain in sportspeople falls into three primary patterns, a “clinical entity” approach: a prospective study of 207 patients.  Br J Sports Med. 2007;  41(4) 247-252; discussion 252
• 4 Irshad K, Feldman L S, Lavoie C, Lacroix V J, Mulder D S, Brown R A. Operative management of “hockey groin syndrome”: 12 years of experience in National Hockey League players.  Surgery. 2001;  130(4) 759-764, discussion 764–766
• 5 Koulouris G. Imaging review of groin pain in elite athletes: an anatomic approach to imaging findings.  AJR Am J Roentgenol. 2008;  191(4) 962-972
• 6 Muschaweck U, Berger L. Minimal repair technique of sportsmen's groin: an innovative open-suture repair to treat chronic inguinal pain.  Hernia. 2010;  14(1) 27-33
• 7 Brennan D, O'Connell M J, 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(1) 162-167
• 8 Zoga A C, Kavanagh E C, Omar I M et al.. Athletic pubalgia and the “sports hernia”: MR imaging findings.  Radiology. 2008;  247(3) 797-807
• 9 Robinson P, Salehi F, Grainger A 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
• 10 Ziprin P, Williams P, Foster M E. External oblique aponeurosis nerve entrapment as a cause of groin pain in the athlete.  Br J Surg. 1999;  86(4) 566-568
• 11 Verrall G M, Slavotinek J P, Fon G T, Barnes P G. Outcome of conservative management of athletic chronic groin injury diagnosed as pubic bone stress injury.  Am J Sports Med. 2007;  35(3) 467-474
• 12 Meyers W C, Foley D P, Garrett W E, Lohnes J H, Mandlebaum B R. PAIN (Performing Athletes with Abdominal or Inguinal Neuromuscular Pain Study Group) . Management of severe lower abdominal or inguinal pain in high-performance athletes.  Am J Sports Med. 2000;  28(1) 2-8
• 13 Hawkins R D, Hulse M A, Wilkinson C, Hodson A, Gibson M. The association football medical research programme: an audit of injuries in professional football.  Br J Sports Med. 2001;  35(1) 43-47
• 14 Agur A. Grant's Atlas of Anatomy. 9th ed. Baltimore, MD: Williams and Wilkins; 1991
• 15 Walheim G G, 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 Schilders E M. Groin injuries in athletes.  Curr Orthop. 2000;  14 418-423
• 17 Lavignolle B, Vital J M, Senegas J et al.. An approach to the functional anatomy of the sacroiliac joints in vivo.  Anat Clin. 1983;  5(3) 169-176
• 18 Nordin M, Frankel V H. Biomechanics of the Hip. In:, Nordin M, Frankel V H, eds. Basic Biomechanics of the Musculoskeletal System. Philadelphia, PA: Lippincott Williams and Wilkins; 2001: 202-221
• 19 Slavotinek J P, Verrall G M, Fon G T, Sage M R. 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) 894-899
• 20 Cunningham P M, 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
• 21 Robinson P, Barron D A, Parsons W, Grainger A J, Schilders E M, O'Connor P J. Adductor-related groin pain in athletes: correlation of MR imaging with clinical findings.  Skeletal Radiol. 2004;  33(8) 451-457
• 22 Verrall G M, Slavotinek J P, Barnes P G, Esterman A, Oakeshott R D, Spriggins A J. Hip joint range of motion restriction precedes athletic chronic groin injury.  J Sci Med Sport. 2007;  10(6) 463-466
• 23 Tyler T F, Nicholas S J, Campbell R J, McHugh M P. 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(2) 124-128
• 24 Verrall G M, Slavotinek J P, Barnes P G, Fon G T. Description of pain provocation tests used for the diagnosis of sports-related chronic groin pain: relationship of tests to defined clinical (pain and tenderness) and MRI (pubic bone marrow oedema) criteria.  Scand J Med Sci Sports. 2005;  15(1) 36-42
• 25 Hölmich P, Uhrskou P, Ulnits L et al.. Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: randomised trial.  Lancet. 1999;  353(9151) 439-443
• 26 Robinson P, Hensor E, Lansdown M J, Ambrose N S, Chapman A H. Inguinofemoral hernia: accuracy of sonography in patients with indeterminate clinical features.  AJR Am J Roentgenol. 2006;  187(5) 1168-1178
• 27 Steele P, Annear P, Grove J R. Surgery for posterior inguinal wall deficiency in athletes.  J Sci Med Sport. 2004;  7(4) 415-421; discussion 422–423
• 28 Orchard J W, Read J W, 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) 134-139