Clinical Examination, Diagnostic Imaging, and Testing of Athletes With Groin Pain: An Evidence-Based Approach to Effective Management

Thorborg, Kristian; Reiman, Michael P.; Weir, Adam; Kemp, Joanne L; Serner, Andreas; Mosler, Andrea Britt; Hölmich, Per

doi:10.2519/jospt.2018.7850

Cited by 80 publications

(55 citation statements)

References 109 publications

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“…Again, caution is suggested as the clinical utility of diagnostic imaging can have only small shifts in post-test probability as a result of either positive or negative findings 45–47. As such, a comprehensive clinical examination, including screening for other conditions that might present with hip-related pain (eg, of the spine and pelvis), is required, and the diagnosis of the cause of hip-related pain should never be made on imaging alone 22 23…”

Section: Discussionmentioning

confidence: 99%

“…For hip-related pain in young active adults, this could for example include Perthes’ disease, slipped capital femoral epiphysis (SCFE), infection, osteoarthritis, tumours and fractures. While it is beyond the scope and purpose of detailing the process of helping to exclude these pathological concerns, the reader is referred to other recent works detailing this process 22 23…”

Section: Introductionmentioning

confidence: 99%

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Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018

et al. 2020

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There is no agreement on how to classify, define or diagnose hip-related pain—a common cause of hip and groin pain in young and middle-aged active adults. This complicates the work of clinicians and researchers. The International Hip-related Pain Research Network consensus group met in November 2018 in Zurich aiming to make recommendations on how to classify, define and diagnose hip disease in young and middle-aged active adults with hip-related pain as the main symptom. Prior to the meeting we performed a scoping review of electronic databases in June 2018 to determine the definition, epidemiology and diagnosis of hip conditions in young and middle-aged active adults presenting with hip-related pain. We developed and presented evidence-based statements for these to a panel of 37 experts for discussion and consensus agreement. Both non-musculoskeletal and serious hip pathological conditions (eg, tumours, infections, stress fractures, slipped capital femoral epiphysis), as well as competing musculoskeletal conditions (eg, lumbar spine) should be excluded when diagnosing hip-related pain in young and middle-aged active adults. The most common hip conditions in young and middle-aged active adults presenting with hip-related pain are: (1) femoroacetabular impingement (FAI) syndrome, (2) acetabular dysplasia and/or hip instability and (3) other conditions without a distinct osseous morphology (labral, chondral and/or ligamentum teres conditions), and that these terms are used in research and clinical practice. Clinical examination and diagnostic imaging have limited diagnostic utility; a comprehensive approach is therefore essential. A negative flexion–adduction–internal rotation test helps rule out hip-related pain although its clinical utility is limited. Anteroposterior pelvis and lateral femoral head–neck radiographs are the initial diagnostic imaging of choice—advanced imaging should be performed only when requiring additional detail of bony or soft-tissue morphology (eg, for definitive diagnosis, research setting or when planning surgery). We recommend clear, detailed and consistent methodology of bony morphology outcome measures (definition, measurement and statistical reporting) in research. Future research on conditions with hip-related pain as the main symptom should include high-quality prospective studies on aetiology and prognosis. The most common hip conditions in active adults presenting with hip-related pain are: (1) FAI syndrome, (2) acetabular dysplasia and/or hip instability and (3) other conditions without distinct osseous morphology including labral, chondral and/or ligamentum teres conditions. The last category should not be confused with the incidental imaging findings of labral, chondral and/or ligamentum teres pathology in asymptomatic people. Future research should refine our current recommendations by determining the clinical utility of clinical examination and diagnostic imaging in prospective studies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018

et al. 2020

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“…Single-factor model coefficients for predicting the risk of a sports hernia diagnosis in football players based on ultrasound findings on the right Widening of the inguinal canal and a protrusion of the "weak zone" of the posterior wall of the inguinal canal in the inguinal canal [8]. In addition, this method provides information on the nature of the changes in the pubic bone and adjacent myotendinosis structures [9,10,11,12]. Along with MRI, ultrasound remains a sufficiently informative method for the examination of this part of the human body [13].…”

Section: Discussionmentioning

confidence: 99%

Mri and Ultrasound Criteria for the Diagnosis of a Sports Hernia in Football Players

Ioffe

Negria²,

Omelchenko

et al. 2020

Wiad Lek

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The aim of the study is to specify diagnostic MRI and ultrasound criteria for a sports hernia in order to verify its diagnosis in football players. Materials and methods: The study included 50 professional and amateur football players aged 15 to 34 from 2016 to 2019. The criteria for inclusion in the study were: the presence of groin pain in football players, which prevented them from continuing to actively participate in sports activities. Results: The findings of the study revealed that during MRI the two factors, which had the strongest influence, were “increased MR signal intensity on PDfs observed from the structures of the inguinal canal” and “increased MR signal intensity on PDfs observed from bone marrow of superior ramus of the pubic bone”. During ultrasound of the inguinal area, the main criterion for a sports hernia diagnosis was “increased size of the inguinal canal”. The verification of the diagnosis was carried out on the basis of the presence of a protrusion in the posterior wall of the inguinal canal. For a sports hernia diagnosis the MRI sensitivity is 91.67% (95% CI 77.5 – 98.2), specificity –78.57% (95% CI 49.2 – 95.3) and the sensitivity of ultrasound is 88.89% (95% CI 73.9 – 96.9), the specificity – 50% (95% CI 23.0 – 77). Conclusions: The combination of MRI and ultrasound makes it possible to accurately detect the presence of a sports hernia in the football player. Based on the findings of our study, we formulated MRI and ultrasound criteria for a sports hernia diagnosis.

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“…The prevalence of chronic groin pain in athletes, as well as adults participating in regular physical activity, ranges between 5 and 10 per cent. Most chronic groin injuries are treated conservatively but sometimes groin surgery may be beneficial.…”

Section: Introductionmentioning

confidence: 99%

“…Contact sports involving sudden muscle contraction with side‐to‐side motion, seen particularly in football, ice hockey and rugby, are most commonly associated with groin injuries. Chronic groin pain has various aetiologies, such as adductor tendonitis, rectus abdominis tendinopathy, osteitis pubis or disruption of the posterior wall of the inguinal canal. The latter may be confirmed by dynamic ultrasonography, and is analogous to an early direct inguinal hernia.…”

Section: Introductionmentioning

confidence: 99%

Randomized clinical trial of open suture repairversustotally extraperitoneal repair for treatment of sportsman's hernia

Sheen

Montgomery

Simon

et al. 2019

British Journal of Surgery

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Background: Sportsman's hernia/athletic pubalgia is a recognized cause of chronic groin pain in athletes. Both open and laparoscopic surgical repairs have been described for treatment, but there are no comparative studies. The hypothesis here was that relief of pain would be achieved earlier in patients treated with open minimal suture repair than totally extraperitoneal repair. Methods: A randomized multicentre trial in four European countries was conducted to compare open minimal suture repair with totally extraperitoneal repair. The primary endpoint was complete relief of pain (visual analogue scale (VAS) score 20 or less on a scale from 0 to 100 mm) at 1 month. Secondary endpoints included complications, time to return to sporting activity, and number of patients returning to sport within 1 year. Results: A total of 65 athletes (92 per cent men) with a median age of 29 years were enrolled (31 open repair, 34 totally extraperitoneal repair). By 4 weeks after surgery, median preoperative VAS scores had dropped from 70-80 to 10-20 in both groups (P < 0⋅001). Relief of pain (VAS score 20 or less) during sports activity 4 weeks after surgery was achieved in 14 of 31 patients after open repair and 24 of 34 after totally extraperitoneal repair (P = 0⋅047). Return to full sporting activity was achieved by 16 and 18 patients respectively after 1 month (P = 0⋅992), and by 25 versus 31 after 3 months (P = 0⋅408). Conclusion: Totally extraperitoneal repair was less painful than open repair in the first month, but otherwise both procedures were similarly effective in treating chronic pain due to sportsman's hernia. Registration number: NCT02297711 (http://www.clinical.trials.gov).

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Clinical Examination, Diagnostic Imaging, and Testing of Athletes With Groin Pain: An Evidence-Based Approach to Effective Management

Cited by 80 publications

References 109 publications

Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018

Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018

Mri and Ultrasound Criteria for the Diagnosis of a Sports Hernia in Football Players

Randomized clinical trial of open suture repairversustotally extraperitoneal repair for treatment of sportsman's hernia

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