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Semin Musculoskelet Radiol 2004; 8(1): 41-55
DOI: 10.1055/s-2004-823014
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Imaging of Hip and Groin Injuries in Athletes

Kimberlee Horton Overdeck1 , William Ewing Palmer1
  • 1Department of Bone and Joint Radiology, Massachusetts General Hospital, Boston, MA
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Publication History

Publication Date:
13 April 2004 (online)

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Proper function of the hip joint is imperative for athletes who participate in sporting activities that rely on utilization of the lower extremity; these primarily include kicking, running, and jumping activities. Sports-related injuries of the hip and groin are not frequent sources of disability in athletes; however, they may present a significant diagnostic dilemma, both from a clinical and radiological standpoint. Delay in diagnosis and treatment may result in undesired complications, such as premature degenerative disease, as well as time lost from athletic activities. Magnetic resonance (MR) imaging of the hip, particularly following the intra-articular administration of gadolinium, has proven to be extremely valuable in the diagnosis of radiographically occult osseous abnormalities as well as soft-tissue injuries, such as pubalgia, musculotendinous abnormalities, and bursitis. This article will review several pathological conditions of the hip and groin in both recreational and professional athletes, with an emphasis on MR imaging as the modality of choice in the diagnosis of these injuries.

KEYWORDS

Hip - athlete - injuries

REFERENCES

  • 1 Boyd K T, Peirce N S, Batt M E. Common hip injuries in sport.  Sports Med. 1997;  24 273-288
    PubMedGoogle Scholar
  • 2 Anderson K, Strickland S M, Warren R. Hip and groin injuries in athletes.  Am J Sports Med. 2001;  29 521-533
    PubMedGoogle Scholar
  • 3 Manaster B J. From the RSNA refresher courses. Adult chronic hip pain: radiographic evaluation.  Radiographics. 2000;  20 S3-S25
    PubMedGoogle Scholar
  • 4 Hayes C W, Balkissoon A A. Magnetic resonance imaging of the musculoskeletal system. II. The hip.  Clin Orthop. 1996;  171 279-309
    PubMedGoogle Scholar
  • 5 Palmer W E. MR arthrography of the hip.  Semin Musculoskelet Radiol. 1998;  2 349-361
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Grainger A J, Elliot J M, Campbell R S et al.. Direct MR arthrography: a review of current use.  Clin Radiol. 2000;  55 163-176
    CrossrefPubMedGoogle Scholar
  • 7 Steinbach L S, Palmer W E, Schweitzer M E. MR arthrography.  Radiographics. 2002;  22 1223-1246
    CrossrefPubMedGoogle Scholar
  • 8 Bencardino J T, Palmer W E. Imaging of hip disorders in athletes.  Radiol Clin North Am. 2002;  40 267-287
    CrossrefPubMedGoogle Scholar
  • 9 Mason J B. Acetabular labral tears in the athlete.  Clin Sports Med. 2001;  20 779-790
    CrossrefPubMedGoogle Scholar
  • 10 Fitzgerald Jr R H. Acetabular labrum tears: diagnosis and treatment.  Clin Orthop. 1995;  211 60-68
    PubMedGoogle Scholar
  • 11 Petersilge C A, Haque M A, Petersilge W J et al.. Acetabular labral tears: evaluation with MR arthrography.  Radiology. 1996;  200 231-235
    CrossrefPubMedGoogle Scholar
  • 12 Czerny C, Hofmann S, Neuhold A et al.. Lesions of the acetabular labrum: accuracy of MR imaging and MR arthrography in detection and staging.  Radiology. 1996;  200 225-230
    CrossrefPubMedGoogle Scholar
  • 13 Lage L A, Patel J V, Villar R N. The acetablular labral tear: an arthroscopic classification.  Arthroscopy. 1996;  12 269-272
    PubMedGoogle Scholar
  • 14 Santori N, Villar R N. Acetabular labral tears: result of arthroscopic partial limbectomy.  Arthroscopy. 2000;  16 11-15
    PubMedGoogle Scholar
  • 15 Dipaola J D, Nelson D W, Colville M R. Characterizing osteochondral lesions by magnetic resonance imaging.  Arthroscopy. 1991;  7 101-104
    CrossrefPubMedGoogle Scholar
  • 16 Bohndorf K. Imaging of acute injuries of the articular surfaces (chondral, osteochondral, and subchondral fractures).  Skeletal Radiol. 1999;  28 545-560
    CrossrefPubMedGoogle Scholar
  • 17 Kramer J, Stiglbauer R, Engel A, Drayer L, Imnof H. MR contrast arthrography (MRA) in osteochondrosis dissecans.  J Comput Assist Tomogr. 1992;  16 254-260
    CrossrefPubMedGoogle Scholar
  • 18 Albers S L, Spritzer C E, Garrett Jr W E, Meyers W C. MR findings in athletes with pubalgia.  Skeletal Radiol. 2001;  30 270-277
    CrossrefPubMedGoogle Scholar
  • 19 O'Connell M J, Powell T, McCaffrey N M, O'Connell D, Eustace S J. Symphyseal cleft injection in the diagnosis and treatment of osteitis pubis in athletes.  AJR Am J Roentgenol. 2002;  179 955-959
    PubMedGoogle Scholar
  • 20 Gilmore J. Groin pain in the soccer athlete: fact, fiction, and treatment.  Clin Sports Med. 1998;  17 787-793
    CrossrefPubMedGoogle Scholar
  • 21 Fon L J, Spence A J. Sportsman's hernia.  Br J Surg. 2000;  87 545-552
    CrossrefPubMedGoogle Scholar
  • 22 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
    PubMedGoogle Scholar
  • 23 Smedberg S G, Broome A EA, Elmer O, Gullmo A. Herniography in the diagnosis of obscure groin pain.  Acta Chir Scand. 1985;  151 663-667
    PubMedGoogle Scholar
  • 24 DeSmet A A, Best T M. MR imaging of the distribution and location of acute hamstring injuries in athletes.  AJR Am J Roentgenol. 2000;  174 393-399
    PubMedGoogle Scholar
  • 25 Kurosawa H, Nakasita K, Nakasita H, Sasaki S, Takeda S. Complete avulsion of the hamstring tendons from the ischial tuberosity: a report of two cases sustained in judo.  Br J Sports Med. 1996;  30 72-74
    CrossrefPubMedGoogle Scholar
  • 26 Takayanagi H, Watanabe H, Shinozaki T et al.. Overgrowth of the ischial tuberosity complicating femoral bone and muscle atrophy: implications for a delayed complication of malunited apophyseal avulsion fracture.  Am J Orthop. 1998;  27 308-312
    PubMedGoogle Scholar
  • 27 Stevens M A, El Khoury G Y, Kathol M H, Brandser E A, Chow S. Imaging features of avulsion injuries.  Radiographics. 1999;  19 655-672
    PubMedGoogle Scholar
  • 28 Afra R, Boardman D L, Kabo J M, Eckhardt J J. Avulsion fracture of the lesser trochanter as a result of a preliminary malignant tumor of bone: a report of four cases.  J Bone Joint Surg Am. 1999;  81 1299-1304
    PubMedGoogle Scholar
  • 29 Phillips C D, Pope Jr T L, Jones J E, Keats T E, MacMillan III R H. Nontraumatic avulsion of the lesser trochanter: a pathognomonic sign of metastatic disease?.  Skeletal Radiol. 1988;  17 106-110
    CrossrefPubMedGoogle Scholar
  • 30 Akcali O, Kossay C, Gunal I, Alici E. Bilateral trochanteric fractures of the femur in a patient with chronic renal failure.  Int Orthop. 2000;  24 179-180
    CrossrefPubMedGoogle Scholar
  • 31 Gibbon W W, Hession P R. Diseases of the pubis and pubic symphysis: MR imaging appearances.  AJR Am J Roentgenol. 1997;  169 849-853
    PubMedGoogle Scholar
  • 32 Palmer W E, Kuong S J, Elmadbouh H M. MR imaging of myotendinous strain.  AJR Am J Roentgenol. 1999;  173 703-709
    CrossrefPubMedGoogle Scholar
  • 33 May D A, Disler D G, Jones E A, Balkissoon A A, Manaster B J. Abnormal signal intensity in skeletal muscle at MR imaging: patterns, pearls, and pitfalls.  Radiographics. 2000;  20 S295-S315
    PubMedGoogle Scholar
  • 34 Temple H T, Kuklo T R, Sweet D E, Gibbons M H, Murphey M D. Rectus femoris muscle tear appearing as a pseudotumor.  Am J Sports Med. 1998;  26 544-548
    PubMedGoogle Scholar
  • 35 Steinbach L S, Fleckenstein J L, Mink J H. Magnetic resonance imaging of muscle injuries.  Orthopedics. 1994;  17 991-999
    PubMedGoogle Scholar
  • 36 Fleckenstein J L, Weatherall P T, Parkey R W, Payne J A, Peshock R M. Sports-related muscle injuries: evaluation with MR imaging.  Radiology. 1989;  172 793-798
    PubMedGoogle Scholar
  • 37 DeSmet A A. Magnetic resonance findings in skeletal muscle tears.  Skeletal Radiol. 1993;  22 479-484
    PubMedGoogle Scholar
  • 38 Friedenstein A Y. Osteogenic stem cells in the bone marrow. In: Heersche JNM, Kanis JA Bone and Mineral Research. Amsterdam; Elsevier Science Publishers 1990: 243-272
    Google Scholar
  • 39 Lipscomb A B, Thomas E D, Johnston R K. Treatment of myositis ossificans traumatica in athletes.  Am J Sports Med. 1976;  4 111-120
    PubMedGoogle Scholar
  • 40 Shin A Y, Gillingham B L. Fatigue fractures of the femoral neck in athletes.  J Am Acad Orthop Surg. 1997;  5 293-302
    PubMedGoogle Scholar
  • 41 Otte M T, Helms C A, Fritz R C. MR imaging of supra-acetabular insufficiency fractures.  Skeletal Radiol. 1997;  26 279-283
    CrossrefPubMedGoogle Scholar
  • 42 Lee J K, Yao L. Stress fractures: MR imaging.  Radiology. 1998;  169 217-220
    PubMedGoogle Scholar
  • 43 Kneeland J B. MR imaging of sports injuries of the hip.  Magn Reson Imaging Clin N Am. 1999;  7 105-115
    PubMedGoogle Scholar
  • 44 Shbeeb M I, Matteson E L. Trochanteric bursitis (greater trochanteric pain syndrome).  Mayo Clin Proc. 1996;  71 565-569
    CrossrefPubMedGoogle Scholar
  • 45 Jones D L, Erhard R E. Diagnosis of trochanteric bursitis versus femoral neck stress fracture.  Phys Ther. 1997;  77 58-67
    PubMedGoogle Scholar
  • 46 Haller C C, Coleman P A, Estes N C, Grisolia A. Traumatic trochanteric bursitis.  Kans Med. 1989;  90 17-18, 22
    PubMedGoogle Scholar
  • 47 Swartout R, Compere E L. Ischiogluteal bursitis; the pain in the arse.  JAMA. 1974;  227 551-552
    CrossrefPubMedGoogle Scholar
  • 48 Kim S M, Shin M J, Kim K S et al.. Imaging features of ischial bursitis with an emphasis on ultrasonography.  Skeletal Radiol. 2002;  31 631-636
    CrossrefPubMedGoogle Scholar
  • 49 Johnston C A, Wiley J P, Lindsay D M, Wiseman D A. Iliopsoas bursitis and tendonitis; a review.  Sports Med. 1998;  25 271-283
    CrossrefPubMedGoogle Scholar
  • 50 Vacarro J P, Sauser D D, Beals R K. Iliopsoas bursa imaging: efficacy in depicting abnormal iliopsoas tendon motion in patients with internal snapping hip syndrome.  Radiology. 1995;  197 853-856
    PubMedGoogle Scholar
  • 51 Pelsser V, Cardinal E, Hobden R, Aubin B, Lafortune M. Extraarticular snapping hip: sonographic findings.  AJR Am J Roentgenol. 2001;  176 67-73
    CrossrefPubMedGoogle Scholar

Kimberlee Horton OverdeckM.D. 

Assistant in Radiology, Massachusetts General Hospital, Department of Bone and Joint Radiology

15 Parkman Street, WACC 515

Boston, MA 02114