Download PDF
Semin Musculoskelet Radiol 2006; 10(3): 197-207
DOI: 10.1055/s-2006-957173
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001 USA.

MR Imaging of Groin Pain in the Athlete

Eoin C. Kavanagh1 , George Koulouris2 , Stephanie Ford3 , Peter McMahon3 , Ciaran Johnson2 , Stephen J. Eustace3
  • 1Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
  • 2Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
  • 3Department of Radiology, Cappagh National Orthopaedic Hospital, Finglas, Dublin, Ireland
Further Information

Publication History

Publication Date:
27 December 2006 (online)

Also available at
    Permissions and Reprints

ABSTRACT

Groin pain is a frequently encountered symptom in the athlete. The differential diagnosis for an athlete presenting with groin pain is broad and diagnostic imaging plays a crucial role in reaching the correct diagnosis, allowing appropriate therapy to be instituted. In this article we present the radiological differential diagnosis of athletes presenting with groin pain. The common mechanisms of injury, presenting symptoms, and imaging findings for each of these entities are addressed.

KEYWORDS

Groin - MRI - pain

REFERENCES

  • 1 Lacroix V J. A complete approach to groin pain.  Phys Sportsmed. 2000;  28 43-52
    PubMedGoogle Scholar
  • 2 Morelli V, Smith V. Groin injuries in athletes.  Am Fam Physician. 2001;  64 1405-1414
    PubMedGoogle Scholar
  • 3 Renstrom P, Peterson L. Groin injuries in athletes.  Br J Sports Med. 1980;  14 30-36
    CrossrefPubMedGoogle Scholar
  • 4 Ruane J J, Rossi T A. When groin pain is more than ‘just a strain’: navigating a broad differential.  Phys Sportsmed. 1998;  26 78-103
    PubMedGoogle Scholar
  • 5 Lynch S A, Renstrom P A. Groin injuries in sport: treatment strategies.  Sports Med. 1999;  28 137-144
    CrossrefPubMedGoogle Scholar
  • 6 Hoelmich P. Adductor-related groin pain in athletes.  Sports Med Arthroscopy Rev. 1997;  5 285-291
    PubMedGoogle Scholar
  • 7 Ahumada L A, Ashruf S, Espinosa-de-los-Monteros A et al.. Athletic pubalgia: definitions and surgical treatment.  Ann Plast Surg. 2005;  55 393-396
    CrossrefPubMedGoogle Scholar
  • 8 Morelli V, Weaver V. Groin injuries and groin pain in athletes: part 1.  Prim Care. 2005;  32 163-183
    CrossrefPubMedGoogle Scholar
  • 9 Albers S L, Spritzer C E, Garrett W E, Meyers W C. MR findings in athletes with pubalgia.  Skeletal Radiol. 2001;  30 270-277
    CrossrefPubMedGoogle Scholar
  • 10 Slavotinek J P, Verrall G M, Fon G T, Sage M R. Groin pain in footballers: the association between preseason clinical and pubic bone magnetic resonance findings and athlete outcome.  Am J Sports Med. 2005;  33 894-899
    CrossrefPubMedGoogle Scholar
  • 11 Kemp S, Batt M E. The ‘sports hernia’: a common cause of groin pain.  Phys Sportsmed. 1998;  26 59-65
    PubMedGoogle Scholar
  • 12 Schnarkowski P, Steinbach L S, Tirman P FJ et al.. Magnetic resonance imaging of labral cysts of the hip.  Skeletal Radiol. 1996;  25 733-737
    CrossrefPubMedGoogle Scholar
  • 13 Boutin R D, Newman J S. MR imaging of sports-related hip disorders.  Magn Reson Imaging Clin N Am. 2003;  11 255-281
    CrossrefPubMedGoogle Scholar
  • 14 Bencardino J T, Palmer W E. Imaging of hip disorders in athletes.  Radiol Clin North Am. 2002;  40 267-287
    CrossrefPubMedGoogle Scholar
  • 15 Kassarjian A, Yoon L S, Belzile E, Connolly S A, Millis M B, Palmer W E. Triad of MR arthrographic findings in patients with cam-type femoroacetabular impingement.  Radiology. 2005;  236 588-592
    CrossrefPubMedGoogle Scholar
  • 16 Janzen D L, Partridge E, Logan P M et al.. The snapping hip: clinical and imaging findings in transient subluxation of the iliopsoas tendon.  Can Assoc Radiol J. 1996;  47 202-208
    PubMedGoogle Scholar
  • 17 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
  • 18 Zeiss J, Saddemi S R, Ebraheim N A. MR imaging of the quadriceps tendon: normal layered configuration and its importance in tendon rupture.  AJR Am J Roentgenol. 1992;  159 1031-1034
    CrossrefPubMedGoogle Scholar
  • 19 Cross T M, Gibbs N, Houang M T, Cameron M. Acute quadriceps muscle strains: magnetic resonance imaging features and prognosis.  Am J Sports Med. 2004;  32 710-719
    CrossrefPubMedGoogle Scholar
  • 20 El-Khoury G Y, Brandser E A, Kathol M H et al.. Imaging of muscle injuries.  Skeletal Radiol. 1996;  25 3-11
    CrossrefPubMedGoogle Scholar
  • 21 Bush C H. The magnetic resonance imaging features of musculoskeletal hemorrhage.  Skeletal Radiol. 2000;  29 1-9
    CrossrefPubMedGoogle Scholar
  • 22 Rossi F, Dragoni S. Acute avulsion fractures of the pelvis in adolescent competitive athletes: prevalence, location and sports distribution of 203 cases collected.  Skeletal Radiol. 2001;  30 127-131
    CrossrefPubMedGoogle Scholar
  • 23 Koulouris G, Connell D. Evaluation of the hamstring muscle complex following acute injury.  Skeletal Radiol. 2003;  32 582-589
    CrossrefPubMedGoogle Scholar
  • 24 Koulouris G, Connell D. Hamstring muscle complex: an imaging review.  Radiographics. 2005;  25 571-586
    CrossrefPubMedGoogle Scholar
  • 25 Slavotinek J P, Verrall G M, Fon G T. Hamstring injury in athletes: using MR imaging measurements to compare extent of muscle injury with amount of time lost from competition.  AJR Am J Roentgenol. 2002;  179 1621-1628
    CrossrefPubMedGoogle Scholar
  • 26 Bird P A, Oakley S P, Shnier R et al.. Prospective evaluation of magnetic resonance imaging and physical examination findings in patients with greater trochanteric pain syndrome.  Arthritis Rheum. 2001;  44 2138-2145
    CrossrefPubMedGoogle Scholar
  • 27 Pfirrmann C WA, Chung C B, Theumann N H et al.. Greater trochanter of the hip: attachment of the abductor mechanism and a complex of three bursae-MR imaging and MR bursography in cadavers and MR imaging in asymptomatic volunteers.  Radiology. 2001;  221 469-477
    CrossrefPubMedGoogle Scholar
  • 28 Heller A. Anatomy of the trochanteric bursae.  Radiology. 2003;  226 921-922
    CrossrefPubMedGoogle Scholar
  • 29 Hosono M, Kobayashi H, Fujimoto R et al.. MR appearances of parasymphyseal insufficiency fractures of the os pubis.  Skeletal Radiol. 1997;  26 525-528
    CrossrefPubMedGoogle Scholar
  • 30 Briggs R C, Kolbjornsen P H, Southall R C. Osteitis pubis, Tc-99m MDP, and professional hockey players.  Clin Nucl Med. 1992;  17 861-863
    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 O'Connell M J, Powell T, McCaffrey N M et al.. Symphyseal cleft injection in the diagnosis and treatment of osteitis pubis in athletes.  AJR Am J Roentgenol. 2002;  179 955-959
    PubMedGoogle Scholar
  • 33 Holt M A, Keen J S, Graf B K et al.. Treatment of osteitis pubis in athletes: results of corticosteroids injections.  Am J Sports Med. 1995;  23 601-606
    PubMedGoogle Scholar
  • 34 Tuite D J, Finegan P J, Saliaris A P et al.. Anatomy of the proximal musculotendinous junction of the adductor longus muscle.  Knee Surg Sports Traumatol Arthrosc. 1998;  6 134-137
    CrossrefPubMedGoogle Scholar
  • 35 Brennan D, O'Connell M J, Ryan M et al.. Secondary cleft sign as a marker of injury in athletes with groin pain: MR image appearance and interpretation.  Radiology. 2005;  235 162-167
    CrossrefPubMedGoogle Scholar
  • 36 Akermark C, Johansson C. Tenotomy of the adductor longus tendon in the treatment of chronic groin pain in athletes.  Am J Sports Med. 1992;  20 640-643
    PubMedGoogle Scholar
  • 37 Johnston C A, Wiley J P, Lindsay D M et al.. Iliopsoas bursitis and tendonitis. A review.  Sports Med. 1998;  25 271-283
    CrossrefPubMedGoogle Scholar
  • 38 Kozlov D B, Sonin A H. Iliopsoas bursitis: diagnosis by MRI.  J Comput Assist Tomogr. 1998;  22 625-628
    CrossrefPubMedGoogle Scholar
  • 39 Varma D G, Richli W R, Charnsangavej C et al.. MR appearances of the distended iliopsoas bursa.  AJR Am J Roentgenol. 1991;  156 1025-1028
    CrossrefPubMedGoogle Scholar
  • 40 Orchard J W, Read J W, Neophyton J, Garlick D. Groin pain associated with ultrasound finding of inguinal canal posterior wall deficiency in Australian Rules footballers.  Br J Sports Med. 1998;  32 134-139
    CrossrefPubMedGoogle Scholar

Eoin C KavanaghM.D. 

Department of Radiology, University of Pittsburgh Medical Center

200 Lothrop Street, Pittsburgh, PA 15213

      >