Groin Pain in Athletes

Abstract

Groin pain in athletes is one of the most difficult to treat clinical entities in sports medicine. The reasons are the amount of differential diagnoses, complexity of pathophysiologic causes and the long time of limited participation in sport. In order to maximize efficient treatment, thorough diagnostics and a clear therapeutic regimen are crucial. To succeed with this issue, a close cooperation between physicians and radiologists is mandatory. MRI is gold standard in the diagnostic work-up of the principal differential diagnoses, such as muscle tears, avulsion injuries, stress fractures, tears of acetabular labrum, and osteitis pubis. The article gives a comprehensive overview of the special anatomy and biomechanics of the pubic region and of typical MRI findings in athletes with groin pain. The use of dedicated imaging protocols is also discussed.

Key Points:

• Groin pain in competitive sports is frequent (5 – 18 % incidence among professional soccer and tennis players).

• The differential diagnoses are numerous and comprise among others extraarticular (e. g. muscle and tendon injuries, stress fractures), intraarticular causes (e. g. femoroacetabular impingement, labral lesions), and osteitis pubis.

• Sports hernia is a clinical diagnosis, the radiologist should exclude or define other causes such as osteitis pubis.

• A labral tear as cause of groin pain can only be reliably diagnosed using direct MR arthrography.

Citation Format:

• Weber MA, Rehnitz C, Ott H et al. Groin Pain in Athletes. Fortschr Röntgenstr 2013; 185: 1139 – 1148

Zusammenfassung

Der Leistenschmerz beim Profisport ist eines der am schwierigsten zu behandelnden Krankheitsbilder in der Sportmedizin. Grund hierfür ist die Fülle von Differenzialdiagnosen, die Komplexität der pathophysiologischen Einflussfaktoren und die mitunter lange Ausfallzeit. Um eine maximal effiziente Therapie zu gewährleisten, sind eine differenzierte Diagnostik und ein klares Therapiekonzept entscheidend. Dies gelingt nur, wenn eine enge Zusammenarbeit zwischen betreuenden Ärzten und Radiologen stattfindet. Die MRT ist der Goldstandard zur Aufarbeitung der wichtigsten Differenzialdiagnosen wie Muskelverletzungen, apophysäre Verletzungen und Stressfrakturen, Labrumpathologien des Hüftgelenks und die Osteitis pubis. Der Artikel gibt einen umfassenden Überblick über die spezielle Anatomie und die Biomechanik der Schamgegend und typische MRT-Befunde bei Athleten mit Leistenschmerzen. Die Verwendung eines dezidierten Bildgebungsprotokolls wird ebenso diskutiert.

Key words

bones - muscular - pelvis - MR imaging - ultrasound - trauma

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