Secondary Cleft Sign as a Marker of Injury in Athletes with Groin Pain: MR Image Appearance and Interpretation

Brennan, Darren D.; O’Connell, Martin; Ryan, M.; Cunningham, Patricia M.; Taylor, David; Cronin, Carmel G.; O’Neill, Patrick J.; Eustace, Stephen

doi:10.1148/radiol.2351040045

Cited by 161 publications

(116 citation statements)

References 13 publications

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“…O'Connell et al (8) recommended injection of local anesthetic into the symphyseal cleft for definitive diagnosis. Brennan et al (12) described the secondary cleft sign in coronal STIR images and also after contrast agent injection into the primary cleft. They claim that secondary cleft sign may imply dysfunction of the adductor, gracilis, or conjoined tendon and thus may obviate an extensive search for other causes of groin pain (12).…”

Section: Discussionmentioning

confidence: 99%

“…Brennan et al (12) described the secondary cleft sign in coronal STIR images and also after contrast agent injection into the primary cleft. They claim that secondary cleft sign may imply dysfunction of the adductor, gracilis, or conjoined tendon and thus may obviate an extensive search for other causes of groin pain (12). Our study suggests that associating musculotendinous pathologies may complicate chronic osteitis pubis cases and secondary cleft sign may be another clue to search for additional injuries to determine the major cause of groin pain.…”

Section: Discussionmentioning

confidence: 99%

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Magnetic resonance findings of osteitis pubis

Kunduracioglu

Yılmaz

Yörübulut³

et al. 2007

Magnetic Resonance Imaging

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Purpose:To determine the correlation of MR findings with clinical features of osteitis pubis and to look for associating injuries complicating chronic cases. Materials and Methods:Pelvic MR images of the 22 elite athletes with groin pain were taken. Correlation analysis between the MR findings and clinical properties was carried out. Results:Six of the MR findings had strong correlation with duration of symptoms. Subchondral bone marrow edema, fluid in symphysis pubis joint, and periarticular edema had significant correlation with acuity of the case. On the contrary, subchondral sclerosis, subchondral resorption and bony margin irregularities, and osteophytes correlated with the chronicity of the case. Associated tendon injuries correlated with the duration of symptoms; i.e., all tendon injuries were in chronic cases. Conclusion:Subchondral bone marrow edema, fluid in symphysis pubis joint, and periarticular edema are the most reliable MRI findings of osteitis pubis that has a history of less than six months. Subchondral sclerosis, subchondral resorption and bony margin irregularities, and osteophytes (or pubic beaking) are the most reliable MRI findings of the chronic disease that has been present for more than six months. Associated pathologies, especially adductor or other tendon injuries, underlie more than half of the chronic cases of osteitis pubis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Magnetic resonance findings of osteitis pubis

Kunduracioglu

Yılmaz

Yörübulut³

et al. 2007

Magnetic Resonance Imaging

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“…According to some authors, 70% of patients affected by pubalgia have an opening in the joint capsule, which can be demonstrated by MRI [24]. Only the most severe alterations of the joint capsule with periarticular fluid collections can be detected at US, and in this case US may be helpful for US guided diagnostic or therapeutic punctures [23] (Fig.…”

Section: Rectus Adductor Symphysis Syndromementioning

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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“…Tears of the aponeurosis connecting the rectus abdominis and the adductor longus muscle can be detected on fluidsensitive MR images as fluidlike areas undermining the aponeurosis (170). Sagittal and coronal oblique planes (perpendicular to the aponeurosis) with a small field of view are recommended (171).…”

Section: Tendon and Bone Injurymentioning

confidence: 99%

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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Secondary Cleft Sign as a Marker of Injury in Athletes with Groin Pain: MR Image Appearance and Interpretation

Abstract: The secondary cleft sign demonstrated at MR imaging is a marker of groin injury in athletes presenting with groin pain.

Cited by 161 publications

References 13 publications

Magnetic resonance findings of osteitis pubis

Magnetic resonance findings of osteitis pubis

US in pubalgia

Hip Imaging in Athletes: Sports Imaging Series

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