Athletic Pubalgia and the “Sports Hernia”: MR Imaging Findings

Zoga, Adam C.; Kavanagh, Eoin C.; Omar, Imran M.; Morrison, William B.; Koulouris, George; Lopez, Hector L.; Chaabra, Avneesh; Domesek, John; Meyers, William C.

doi:10.1148/radiol.2473070049

Cited by 217 publications

(156 citation statements)

References 25 publications

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“…The often nonspecific clinical presentation of athletes with hip and/or groin pain requires a thorough evaluation of the hip joint itself on MR images, but the surrounding soft tissues are equally important. of patients with athletic pubalgia (169). Other imaging signs are edema or atrophy of the rectus abdominis muscle attachment.…”

Section: Discussionmentioning

confidence: 99%

“…While acute injury of the aponeurosis is commonly seen in athletes, the pubic symphysis may also show chronic changes: Osteitis pubis manifests as osseous irregularities of the pubic symphysis with erosions, productive changes such as sclerosis and osteophytes. Osteitis pubis may be present without damage to the aponeurotic plate (169).…”

Section: Discussionmentioning

confidence: 99%

“…However, this so-called secondary cleft sign only has moderate sensitivity (57%) and specificity (60%) for diagnosing injury of the aponeurosis (169). Recently, a superior cleft sign has been described as a sign for tearing of the rectus abdominis/adductor longus junction more cranially (172).…”

Section: Discussionmentioning

confidence: 99%

“…This leads to a prominent aponeurotic plate, connecting the distal rectus abdominis attachment, the pubic symphysis, and the adductor longus origin. Close anatomic proximity of these structures with the medial border of the superficial inguinal ring may explain inguinal hernia-like symptoms in patients with athletic pubalgia, even though true hernias are absent in these patients (169).…”

Section: Anatomymentioning

confidence: 99%

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Hip Imaging in Athletes: Sports Imaging Series

et al. 2016

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Hip or groin pain in athletes is common and clinical presentation is often nonspecific. Imaging is a very important diagnostic step in the work-up of athletes with hip pain. This review article provides an overview on hip biomechanics and discusses strategies for hip imaging modalities such as radiography, ultrasonography, computed tomography, and magnetic resonance (MR) imaging (MR arthrography and traction MR arthrography). The authors explain current concepts of femoroacetabular impingement and the problem of high prevalence of cam-and pincer-type morphology in asymptomatic persons. With the main focus on MR imaging, the authors present abnormalities of the hip joint and the surrounding soft tissues that can occur in athletes: intraarticular and extraarticular hip impingement syndromes, labral and cartilage disease, microinstability of the hip, myotendinous injuries, and athletic pubalgia. Hip or groin pain in athletes is common and clinical presentation is often nonspecific. Imaging is a very important diagnostic step in the work-up of athletes with hip pain. This review article provides an overview on hip biomechanics and discusses strategies for hip imaging modalities such as radiography, ultrasonography, computed tomography, and magnetic resonance (MR) imaging (MR arthrography and traction MR arthrography). The authors explain current concepts of femoroacetabular impingement and the problem of high prevalence of cam-and pincer-type morphology in asymptomatic persons. With the main focus on MR imaging, the authors present abnormalities of the hip joint and the surrounding soft tissues that can occur in athletes: intraarticular and extraarticular hip impingement syndromes, labral and cartilage disease, microinstability of the hip, myotendinous injuries, and athletic pubalgia. After reading the article and taking the test, the reader will be able to:n Describe biomechanical implications of torsional malalignment and other atypical forms of hip impingement n Describe the most common MR imaging findings in femoroacetabular impingement and identify anatomic variants n Describe imaging characteristics of a Morel-Lavallée lesion and identify the anatomic compartment where this lesion typically occurs n Identify common stress fractures around the hip joint in athletes and discuss potential complications n Describe features of myotendinous injuries around the hip n Describe the anatomic relationship of the sacrotuberous ligament and the origin of the hamstring tendons n Describe the anatomic structures involved in an athletic pubalgia Accreditation and Designation Statement The RSNA is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The RSNA designates this journal-based SA-CME activity for a maximum of 1.0 AMA PRA Category 1 Credit ™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity. Disclosure StatementThe ACCME requires that the RSNA, as an accredited prov...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Anatomymentioning

confidence: 99%

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Hip Imaging in Athletes: Sports Imaging Series

et al. 2016

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“…The very term "sports hernia" or "sportsman's hernia" was relatively recently introduced, and some authors interpret it as a hernia affecting a person practising sports while others interpret it as a synonym for pubalgia [3] thus adding confusion also to simple literature searches. According to some authors [4] the term pubalgia should cover only the pathology of the wall (pubalgia Z sports hernia) while other causes should have their own denomination.…”

Section: Introductionmentioning

confidence: 99%

US in pubalgia

Balconi

2011

Journal of Ultrasound

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KEYWORDSPubalgia; Sports hernia; Ultrasound.Abstract There is considerable confusion over the word "pubalgia" with regard to the definition and the etiological causes of this condition. The term pubalgia should be used to indicate disabling pain affecting the pubic region in people who practise sports. Pubalgia affects 10% of those who practise sports and it is particularly prevalent in football players. According to the literature, about 40% of cases of pubalgia are caused by overuse of the symphysis pubis with progressive lesions affecting the rectus abdominal muscles, adductors (rectal-adductor syndrome) and the symphysis itself (osteitis pubis and joint injury). An initial study of the tendons is carried out by ultrasound (US) whereas magnetic resonance imaging (MRI) should be performed to study the bones and joints.Another 40% of cases of pubalgia are caused by "sports hernia" defined as anteroinferior abdominal wall insufficiency. These alterations can only be identified at dynamic US examination.About 20% of cases of pubalgia are caused by diseases of the neighboring structures or joints such as diseases of the hip, iliopsoas, hamstring, sacred iliac or nerves, or by urogenital diseases.Sommario Vi è notevole confusione circa la parola "pubalgia", sia per quanto riguarda la sua definizione sia per quanto riguarda le sue cause etiologiche. Il termine di pubalgia dovrebbe essere utilizzato per indicare una sintomatologia dolorosa, invalidante che interessa la regione pubica di chi pratica attività sportiva. Sono interessati il 10% di chi pratica attività sportiva con prevalenza per il footbal. Dalla revisione della letteratura circa il 40% delle pubalgie sono da ricondurre a sovraccarico funzionale sulla sinfisi pubica con lesioni progressive che interessano i retti addominali, gli adduttori (sindrome retto-adduttoria), e la sinfisi stessa (osteite pubica e danno alla articolazione). Lo studio dei tendini trova nella ecografia il primo approccio diagnostico riservando alla RM lo studio della componente ossea e articolare.Un altro 40% dei casi di pubalgia riconosce la causa etiologica nella "sport hernia", definibile come una insufficienza della parete addominale antero-inferiore. La diagnostica ecografica è l'unica in grado di rilevare tali alterazioni che necessitano per essere individuate un esame dinamico.Infine in circa il 20% dei casi la pubalgia è causata da patologie di strutture o apparati limitrofi: patologia dell'anca, dell'ileo-psoas, degli hamstring, della sacro iliaca o dei nervi, fino alle patologie urogenitali. ª

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Anatomical and mechanical relationship between the proximal attachment of adductor longus and the distal rectus sheath

et al. 2012

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The objectives of this study were to investigate the anatomical relationship between the proximal adductor longus (AL) and rectus abdominis muscles and to determine whether unilateral loading of AL results in strain transmission across the anterior pubic symphysis to the contralateral distal rectus sheath. Bilateral dissections were conducted on 10 embalmed cadavers. Strain transfer across the pubic symphysis was examined on seven of these cadavers. An AL contraction was simulated by applying a controlled load in the direction of its proximal tendinous fibers, and the resultant strain in the contralateral distal rectus sheath was measured using a foil-type surface mounted microstrain gage. Adductor longus attached to the antero-inferior aspect of the pubis. In 18 of the 20 limbs, the proximal attachment of AL was tendinous on its superficial surface and muscular on its deep surface. The proximal AL tendon was found in most instances to have secondary communications with structures such as the contralateral distal rectus sheath, pubic symphysis anterior capsule, ilio-inguinal ligament, and contralateral proximal AL tendon. Despite these consistent anatomical observations, strain measured in the contralateral distal rectus sheath upon unilateral loading of the proximal AL varied considerably between cadavers. Measured strain had an average ± 1SD of 0.23 ± 0.43%. The proximal attachment of AL contributes to an anatomical pathway across the anterior pubic symphysis that is likely required to withstand the transmission of large forces during multidirectional athletic activities. This anatomical relationship may be a relevant factor in explaining the apparent vulnerability of the AL and rectus abdominis attachments to injury.

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Athletic Pubalgia and the “Sports Hernia”: MR Imaging Findings

Abstract: MR imaging depicts patterns of findings in patients with athletic pubalgia, including rectus abdominis insertional injury, thigh adductor injury, and articular diseases at the pubic symphysis (osteitis pubis).

Cited by 217 publications

References 25 publications

Hip Imaging in Athletes: Sports Imaging Series

Hip Imaging in Athletes: Sports Imaging Series

US in pubalgia

Anatomical and mechanical relationship between the proximal attachment of adductor longus and the distal rectus sheath

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