Skip to main content
Top
Published in: European Journal of Orthopaedic Surgery & Traumatology 8/2014

01-12-2014 | General Review

Emerging intra-articular causes of groin pain in athletes

Authors: Prajyot Jagtap, Gautam Shetty, Prashant Mane, Vijay Shetty

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 8/2014

Login to get access

Abstract

Groin pain remains one of the most poorly understood conditions in clinical sports medicine. It may be caused by either extra-articular or intra-articular conditions. While extra-articular causes have been extensively studied and reasonably understood, a number of elusive intra-articular causes are emerging, many of which were previously unknown and therefore undiagnosed, leading to premature ending of many competitive careers. This article makes an attempt to look at various, elusive intra-articular causes of groin pain in athletes. This article also analyses the currently available evidence on trends in diagnosis and treatment for these conditions.
Literature
1.
go back to reference Karlsson J, Sward L, Kalebo P et al (1994) Chronic groin pain athletes. Recommendations for treatment and rehabilitation. Sports Med 17:141–148PubMedCrossRef Karlsson J, Sward L, Kalebo P et al (1994) Chronic groin pain athletes. Recommendations for treatment and rehabilitation. Sports Med 17:141–148PubMedCrossRef
3.
go back to reference Hoelmich P (1997) Adductor-related groin pain in athletes -. Sports Med Arthrosc 5:285–291 Hoelmich P (1997) Adductor-related groin pain in athletes -. Sports Med Arthrosc 5:285–291
5.
go back to reference Shetty VD (2008) Persistent: anterior hip pain in young adults: current aspects of diagnosis. Hip Int 18:61–67PubMed Shetty VD (2008) Persistent: anterior hip pain in young adults: current aspects of diagnosis. Hip Int 18:61–67PubMed
6.
go back to reference Ekberg O, Persson NH, Abrahamsson PA et al (1988) Longstanding groin pain in athletes. A multidisciplinary approach. Sports Med 6:56–61PubMedCrossRef Ekberg O, Persson NH, Abrahamsson PA et al (1988) Longstanding groin pain in athletes. A multidisciplinary approach. Sports Med 6:56–61PubMedCrossRef
7.
go back to reference Morelli V, Weaver V (2005) Groin injuries and groin pain in athletes: part 1. Prim Care 32(1):163–183PubMedCrossRef Morelli V, Weaver V (2005) Groin injuries and groin pain in athletes: part 1. Prim Care 32(1):163–183PubMedCrossRef
8.
go back to reference Wettstein M, Mouhsine E, Borens O et al (2007) Differential diagnosis of groin pain [French]. Rev Med Suisse 3(138):2882–2884, 2886–2888 Wettstein M, Mouhsine E, Borens O et al (2007) Differential diagnosis of groin pain [French]. Rev Med Suisse 3(138):2882–2884, 2886–2888
10.
go back to reference Cardinal E, Buckwalter KA, Capello WN et al (1996) US of the snapping iliopsoas tendon. Radiology 198:521–522PubMedCrossRef Cardinal E, Buckwalter KA, Capello WN et al (1996) US of the snapping iliopsoas tendon. Radiology 198:521–522PubMedCrossRef
11.
go back to reference Janzen DL, Partridge E, Logan PM et al (1996) The snapping hip: clinical and imaging findings in transient subluxation of the iliopsoas tendon. Can Assoc Radiol J 47:202–208PubMed Janzen DL, Partridge E, Logan PM et al (1996) The snapping hip: clinical and imaging findings in transient subluxation of the iliopsoas tendon. Can Assoc Radiol J 47:202–208PubMed
12.
go back to reference Harmon KG (2007) Evaluation of groin pain in athletes. Curr Sports Med Rep 6:354–361PubMed Harmon KG (2007) Evaluation of groin pain in athletes. Curr Sports Med Rep 6:354–361PubMed
13.
go back to reference Bogost GA, Lizerbram EK, Crues JV III (1995) MR imaging in evaluation of suspected hip fracture: frequency of unsuspected bone and soft-tissue injury. Radiology 197:263–267PubMedCrossRef Bogost GA, Lizerbram EK, Crues JV III (1995) MR imaging in evaluation of suspected hip fracture: frequency of unsuspected bone and soft-tissue injury. Radiology 197:263–267PubMedCrossRef
14.
go back to reference Weaver CJ, Major NM, Garrett WE et al (2002) Femoral head osteochondral lesions in painful hips of athletes: MR imaging findings. Am J Roentgenol (AJR) 178:973–977CrossRef Weaver CJ, Major NM, Garrett WE et al (2002) Femoral head osteochondral lesions in painful hips of athletes: MR imaging findings. Am J Roentgenol (AJR) 178:973–977CrossRef
15.
go back to reference Williams TR, Puckett ML, Denison G et al (2002) Acetabular stress fractures in military endurance athletes and recruits: incidence and MRI and scintigraphic findings -. Skeletal Radiol 31:277–281PubMedCrossRef Williams TR, Puckett ML, Denison G et al (2002) Acetabular stress fractures in military endurance athletes and recruits: incidence and MRI and scintigraphic findings -. Skeletal Radiol 31:277–281PubMedCrossRef
16.
go back to reference Yamamoto T, Takabatake K, Iwamoto Y (2002) Subchondral insufficiency fracture of the femoral head resulting in rapid destruction of the hip joint: a sequential radiographic study. Am J Roentgenol (AJR) 178:435–437CrossRef Yamamoto T, Takabatake K, Iwamoto Y (2002) Subchondral insufficiency fracture of the femoral head resulting in rapid destruction of the hip joint: a sequential radiographic study. Am J Roentgenol (AJR) 178:435–437CrossRef
17.
go back to reference Seldes RM, Tan V, Hunt J et al (2001) Anatomy, histologic features and vascularity of the adult acetabular labrum. Clin Orthop Relat Res 382:232–240PubMedCrossRef Seldes RM, Tan V, Hunt J et al (2001) Anatomy, histologic features and vascularity of the adult acetabular labrum. Clin Orthop Relat Res 382:232–240PubMedCrossRef
18.
go back to reference Kneeland JB (1997) MR imaging of sports injuries of the hip. Magn Reson Imaging Clin N Am 7:105 Kneeland JB (1997) MR imaging of sports injuries of the hip. Magn Reson Imaging Clin N Am 7:105
19.
go back to reference Hickman JM, Peters CL (2001) Hip pain in the young adult: diagnosis and treatment of disorders of the acetabular labrum and acetabular dysplasia. Am J Orthop 30:459–467PubMed Hickman JM, Peters CL (2001) Hip pain in the young adult: diagnosis and treatment of disorders of the acetabular labrum and acetabular dysplasia. Am J Orthop 30:459–467PubMed
20.
go back to reference Petersilge CA (2001) MR arthrography for evaluation of the acetabular labrum. Skeletal Radiol 30:423–430PubMedCrossRef Petersilge CA (2001) MR arthrography for evaluation of the acetabular labrum. Skeletal Radiol 30:423–430PubMedCrossRef
21.
go back to reference Allen WC, Cope R (1995) Coxa saltans: the snapping hip revisited. J Am Acad Orthop Surg 3:303–308PubMed Allen WC, Cope R (1995) Coxa saltans: the snapping hip revisited. J Am Acad Orthop Surg 3:303–308PubMed
22.
go back to reference Provencher MT, Hofmeister EP, Muldoon MP (2004) The surgical treatment of external coxa saltans (the snapping hip) by Z-plasty of the iliotibial band. Am J Sports Med 32:470–476PubMedCrossRef Provencher MT, Hofmeister EP, Muldoon MP (2004) The surgical treatment of external coxa saltans (the snapping hip) by Z-plasty of the iliotibial band. Am J Sports Med 32:470–476PubMedCrossRef
23.
go back to reference Wunderbaldinger P, Bremer C, Schellenberger E et al (2002) Imaging features of iliopsoas bursitis. Eur Radiol 12:409–415PubMedCrossRef Wunderbaldinger P, Bremer C, Schellenberger E et al (2002) Imaging features of iliopsoas bursitis. Eur Radiol 12:409–415PubMedCrossRef
24.
go back to reference Khanduja V, Villar RN (2007) The arthroscopic management of femoroacetabular impingement. Knee Surg Sports Traumatol Arthrosc 15:1035–1040PubMedCrossRef Khanduja V, Villar RN (2007) The arthroscopic management of femoroacetabular impingement. Knee Surg Sports Traumatol Arthrosc 15:1035–1040PubMedCrossRef
25.
go back to reference McCarthy JC, Barsoum W, Puri L et al (2003) The role of hip arthroscopy in the elite athlete. Clin Orthop Relat Res 406:71–74PubMedCrossRef McCarthy JC, Barsoum W, Puri L et al (2003) The role of hip arthroscopy in the elite athlete. Clin Orthop Relat Res 406:71–74PubMedCrossRef
26.
go back to reference McCarthy JC, Lee JA (2005) Hip Arthroscopy: indications, outcomes and complications. J Bone Joint Surg 87-A:1138–1145 McCarthy JC, Lee JA (2005) Hip Arthroscopy: indications, outcomes and complications. J Bone Joint Surg 87-A:1138–1145
27.
go back to reference Shetty VD, Villar RN (2007) Hip arthroscopy: current concepts and review of literature. Br J Sport Med 41:64–68CrossRef Shetty VD, Villar RN (2007) Hip arthroscopy: current concepts and review of literature. Br J Sport Med 41:64–68CrossRef
28.
go back to reference Lubowitz JH, Poehling GG (2006) Hip arthroscopy: an emerging gold standard. Arthroscopy 22:1257–1259PubMedCrossRef Lubowitz JH, Poehling GG (2006) Hip arthroscopy: an emerging gold standard. Arthroscopy 22:1257–1259PubMedCrossRef
29.
go back to reference Parvizi J, Leunig M, Ganz R (2007) Femoroacetabular impingement. J Am Acad Orthop Surg 15:561–570PubMed Parvizi J, Leunig M, Ganz R (2007) Femoroacetabular impingement. J Am Acad Orthop Surg 15:561–570PubMed
30.
go back to reference Ganz R, Gill TJ, Gautier E et al (2001) Surgical dislocation of the adult hip: a technique with full access to femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg 83-B:1119–1124CrossRef Ganz R, Gill TJ, Gautier E et al (2001) Surgical dislocation of the adult hip: a technique with full access to femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg 83-B:1119–1124CrossRef
31.
go back to reference Beck M, Kalhor M, Leunig M et al (2005) Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg 87-B:1012–1018CrossRef Beck M, Kalhor M, Leunig M et al (2005) Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg 87-B:1012–1018CrossRef
32.
33.
go back to reference Philippon MJ, Schenker ML (2006) Arthroscopy for the treatment of femoroacetabular impingement in the athlete -. Clin Sports Med 25:299–308PubMedCrossRef Philippon MJ, Schenker ML (2006) Arthroscopy for the treatment of femoroacetabular impingement in the athlete -. Clin Sports Med 25:299–308PubMedCrossRef
34.
go back to reference Menigiardi B, Pfirrmann CWA, Hodler J (2007) Hip pain in adults: MR imaging appearance of common causes. Eur Radiol 17:1746–1762CrossRef Menigiardi B, Pfirrmann CWA, Hodler J (2007) Hip pain in adults: MR imaging appearance of common causes. Eur Radiol 17:1746–1762CrossRef
35.
go back to reference Beck M, Leunig M, Parvizi J et al (2004) Anterior femoroacetabular impingement: II. Clinical midterm results. Clin Orthop Relat Res 418:67–73PubMedCrossRef Beck M, Leunig M, Parvizi J et al (2004) Anterior femoroacetabular impingement: II. Clinical midterm results. Clin Orthop Relat Res 418:67–73PubMedCrossRef
36.
go back to reference Sampson TG (2005) Arthroscopic treatment of femoroacetabular impingement. Tech Orthop 20:56–62CrossRef Sampson TG (2005) Arthroscopic treatment of femoroacetabular impingement. Tech Orthop 20:56–62CrossRef
37.
go back to reference Burnett RS, Della Roca GJ, Prather H et al (2006) Clinical presentation of patients with tears of the acetabular labrum. J Bone Joint Surg 88-A:1448–1457CrossRef Burnett RS, Della Roca GJ, Prather H et al (2006) Clinical presentation of patients with tears of the acetabular labrum. J Bone Joint Surg 88-A:1448–1457CrossRef
38.
go back to reference Yamamoto Y, Hamada Y, Ide T et al (2005) Arthroscopic surgery to treat intra-articular type snapping hip. Arthroscopy 21:1120–1125PubMedCrossRef Yamamoto Y, Hamada Y, Ide T et al (2005) Arthroscopic surgery to treat intra-articular type snapping hip. Arthroscopy 21:1120–1125PubMedCrossRef
39.
go back to reference Keeney JA, Peelle MW, Jackson J et al (2004) Magnetic resonance arthrography versus arthroscopy in the evaluation of articular hip pathology. Clin Orthop Relat Res 429:163–169 Keeney JA, Peelle MW, Jackson J et al (2004) Magnetic resonance arthrography versus arthroscopy in the evaluation of articular hip pathology. Clin Orthop Relat Res 429:163–169
40.
go back to reference McCarthy JC, Busconi B (1995) The role of hip arthroscopy in the diagnosis and treatment of hip disease. Orthopedics 18:753–756PubMed McCarthy JC, Busconi B (1995) The role of hip arthroscopy in the diagnosis and treatment of hip disease. Orthopedics 18:753–756PubMed
42.
go back to reference McCarthy JC, Lee JA (2002) Acetabular dysplasia: a paradigm of arthroscopic examination of chondral injuries. Clin Orthop Relat Res 405:122–128PubMedCrossRef McCarthy JC, Lee JA (2002) Acetabular dysplasia: a paradigm of arthroscopic examination of chondral injuries. Clin Orthop Relat Res 405:122–128PubMedCrossRef
43.
go back to reference McCarthy JC, Noble PC, Schuck MR et al (2001) The Otto E. Autofranc award: the role of labral lesions to development of early hip disease. Clin Orthop Relat Res 393:25–37PubMedCrossRef McCarthy JC, Noble PC, Schuck MR et al (2001) The Otto E. Autofranc award: the role of labral lesions to development of early hip disease. Clin Orthop Relat Res 393:25–37PubMedCrossRef
44.
go back to reference Dorfmann H, Boyer T (1999) Arthroscopy of the hip: 12 years of experience. Arthroscopy 15:67–72PubMedCrossRef Dorfmann H, Boyer T (1999) Arthroscopy of the hip: 12 years of experience. Arthroscopy 15:67–72PubMedCrossRef
45.
go back to reference Fitzgerald RH Jr (1995) Acetabular labrum tears. Diagnosis and treatment. Clin Orthop Relat Res 311:60–68PubMed Fitzgerald RH Jr (1995) Acetabular labrum tears. Diagnosis and treatment. Clin Orthop Relat Res 311:60–68PubMed
46.
go back to reference McCarthy JC, Noble PC, Schuck MR et al (2001) The watershed labral lesion: its relationship to early arthritis of the hip. J Arthroplasty 16(Suppl 1):81–87PubMedCrossRef McCarthy JC, Noble PC, Schuck MR et al (2001) The watershed labral lesion: its relationship to early arthritis of the hip. J Arthroplasty 16(Suppl 1):81–87PubMedCrossRef
47.
go back to reference Lage LA, Patel JV, Villar RN (1996) The acetabular labral tear: an arthroscopic classification. Arthroscopy 12:269–272PubMedCrossRef Lage LA, Patel JV, Villar RN (1996) The acetabular labral tear: an arthroscopic classification. Arthroscopy 12:269–272PubMedCrossRef
48.
49.
50.
go back to reference Peters CL, Erickson JA (2006) Treatment of femoroacetabular impingement with surgical dislocation and debridement in young adults. J Bone Joint Surg Am 88-A:1735–1741CrossRef Peters CL, Erickson JA (2006) Treatment of femoroacetabular impingement with surgical dislocation and debridement in young adults. J Bone Joint Surg Am 88-A:1735–1741CrossRef
51.
go back to reference Spencer S, Millis MB, Kim YJ (2006) Early results of treatment of hip impingement syndrome in slipped capital femoral epiphysis and pistol grip deformity of the femoral head–neck junction using the surgical dislocation technique. J Pediatr Orthop 26:281–285PubMedCrossRef Spencer S, Millis MB, Kim YJ (2006) Early results of treatment of hip impingement syndrome in slipped capital femoral epiphysis and pistol grip deformity of the femoral head–neck junction using the surgical dislocation technique. J Pediatr Orthop 26:281–285PubMedCrossRef
52.
go back to reference Brignall CG, Brown RM, Stainsby GD (1993) Fibrosis of the gluteus maximus as a cause of snapping hip. A case report. J Bone Joint Surg 75-A:909–910 Brignall CG, Brown RM, Stainsby GD (1993) Fibrosis of the gluteus maximus as a cause of snapping hip. A case report. J Bone Joint Surg 75-A:909–910
53.
go back to reference Tatu L, Parratte B, Vuillier F et al (2001) Descriptive anatomy of the femoral portion of the iliopsoas muscle. Anatomical basis of anterior snapping of the hip. Surg Radiol Anat 23:371–374PubMedCrossRef Tatu L, Parratte B, Vuillier F et al (2001) Descriptive anatomy of the femoral portion of the iliopsoas muscle. Anatomical basis of anterior snapping of the hip. Surg Radiol Anat 23:371–374PubMedCrossRef
54.
go back to reference Troum OM, Crues JV III (2004) The young adult with hip pain: diagnosis and medical treatment. Clin Orthop 418:9–17 Troum OM, Crues JV III (2004) The young adult with hip pain: diagnosis and medical treatment. Clin Orthop 418:9–17
55.
go back to reference Wunderbaldinger P, Bremer C, Matuszewski L et al (2001) Efficient radiological assessment of the internal snapping hip syndrome. Eur Radiol 11:1743–1747PubMedCrossRef Wunderbaldinger P, Bremer C, Matuszewski L et al (2001) Efficient radiological assessment of the internal snapping hip syndrome. Eur Radiol 11:1743–1747PubMedCrossRef
56.
go back to reference Dobbs MB, Gordon JE, Luhmann SJ, Szymanski DA et al (2002) Surgical correction of the snapping iliopsoas tendon in adolescents. J Bone Joint Surg 84-A:420–424PubMed Dobbs MB, Gordon JE, Luhmann SJ, Szymanski DA et al (2002) Surgical correction of the snapping iliopsoas tendon in adolescents. J Bone Joint Surg 84-A:420–424PubMed
57.
go back to reference Taylor GR, Clarke NM (1995) Surgical release of the ‘snapping iliopsoas tendon’. J Bone Joint Surg 77-B:881–883 Taylor GR, Clarke NM (1995) Surgical release of the ‘snapping iliopsoas tendon’. J Bone Joint Surg 77-B:881–883
58.
go back to reference Ilizaliturri VM Jr, Villalobos FE Jr, Chaidez PA et al (2005) Internal snapping hip syndrome: treatment by endoscopic release of the iliopsoas tendon. Arthroscopy 21:1375–1380PubMedCrossRef Ilizaliturri VM Jr, Villalobos FE Jr, Chaidez PA et al (2005) Internal snapping hip syndrome: treatment by endoscopic release of the iliopsoas tendon. Arthroscopy 21:1375–1380PubMedCrossRef
59.
go back to reference Rao J, Zhou YX, Villar RN (2001) Injury to the ligamentum teres: mechanism, findings, and results of treatment. Clin Sports Med 20:1–6CrossRef Rao J, Zhou YX, Villar RN (2001) Injury to the ligamentum teres: mechanism, findings, and results of treatment. Clin Sports Med 20:1–6CrossRef
60.
go back to reference Byrd JWT (2001) Lateral impact injury. A source of occult hip pathology. Clin Sports Med 20:1–11CrossRef Byrd JWT (2001) Lateral impact injury. A source of occult hip pathology. Clin Sports Med 20:1–11CrossRef
61.
go back to reference Millis MB, Kocher MS (2002) Hip, pelvis, femur: pediatric aspects. In: Koval KJ (ed) Orthopedic knowledge update 7. American Academy of Orthopaedic Surgeons, Chicago, pp 387–394 Millis MB, Kocher MS (2002) Hip, pelvis, femur: pediatric aspects. In: Koval KJ (ed) Orthopedic knowledge update 7. American Academy of Orthopaedic Surgeons, Chicago, pp 387–394
62.
go back to reference Byrd JWT, Jones KS (2000) Prospective analysis of hip arthroscopy with 2-year follow-up. Arthroscopy 16:578–587PubMedCrossRef Byrd JWT, Jones KS (2000) Prospective analysis of hip arthroscopy with 2-year follow-up. Arthroscopy 16:578–587PubMedCrossRef
63.
go back to reference Byrd JWT (1996) Hip arthroscopy for post-traumatic loose fragments in the young active adult: three case reports. Clin Sports Med 6:129–134CrossRef Byrd JWT (1996) Hip arthroscopy for post-traumatic loose fragments in the young active adult: three case reports. Clin Sports Med 6:129–134CrossRef
65.
go back to reference Narvani AA, Tsiridis E, Kendall S et al (2003) A preliminary report on prevalence of acetabular labrum tears in sports patients with groin pain. Knee Surg Sports Traumatol Arthrosc 11:403–408PubMedCrossRef Narvani AA, Tsiridis E, Kendall S et al (2003) A preliminary report on prevalence of acetabular labrum tears in sports patients with groin pain. Knee Surg Sports Traumatol Arthrosc 11:403–408PubMedCrossRef
66.
go back to reference Brown MD, Gomez-Marin O, Brookfield KF et al (2004) Differential diagnosis of hip disease versus spine disease. Clin Orthop Relat Res 419:280–284 Brown MD, Gomez-Marin O, Brookfield KF et al (2004) Differential diagnosis of hip disease versus spine disease. Clin Orthop Relat Res 419:280–284
67.
go back to reference Mitchell B, McCrory P, Brukner P et al (2003) Hip joint pathology: clinical presentation and correlation between magnetic resonance arthrography, ultrasound, and arthroscopic findings in 25 consecutive cases. Clin J Sport Med 13:152–156PubMedCrossRef Mitchell B, McCrory P, Brukner P et al (2003) Hip joint pathology: clinical presentation and correlation between magnetic resonance arthrography, ultrasound, and arthroscopic findings in 25 consecutive cases. Clin J Sport Med 13:152–156PubMedCrossRef
68.
go back to reference Birrell F, Croft P, Cooper C et al (2001) Predicting radiographic hip osteoarthritis from range of movement. Rheumatology (Oxford) 40:506–512CrossRef Birrell F, Croft P, Cooper C et al (2001) Predicting radiographic hip osteoarthritis from range of movement. Rheumatology (Oxford) 40:506–512CrossRef
69.
go back to reference Altman R, Alarcon G, Appelrouth D et al (1991) The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum 34:505–514PubMedCrossRef Altman R, Alarcon G, Appelrouth D et al (1991) The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum 34:505–514PubMedCrossRef
Metadata
Title
Emerging intra-articular causes of groin pain in athletes
Authors
Prajyot Jagtap
Gautam Shetty
Prashant Mane
Vijay Shetty
Publication date
01-12-2014
Publisher
Springer Paris
Published in
European Journal of Orthopaedic Surgery & Traumatology / Issue 8/2014
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI
https://doi.org/10.1007/s00590-013-1325-8

Other articles of this Issue 8/2014

European Journal of Orthopaedic Surgery & Traumatology 8/2014 Go to the issue