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Published in: Skeletal Radiology 5/2016

01-05-2016 | Review Article

Sonographic evaluation of athletic pubalgia

Authors: Nicholas Morley, Thomas Grant, Kevin Blount, Imran Omar

Published in: Skeletal Radiology | Issue 5/2016

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Abstract

Athletic pubalgia, or “sports hernia”, represents a constellation of pathologic conditions occurring at and around the pubic symphysis. These injuries are primarily seen in athletes or those involved in athletic activity. In this article, we review the sonographic appearance of the relevant complex anatomy, scanning technique for ultrasound evaluation of athletic pubalgia, and the sonographic appearances of associated pathologic conditions.
Literature
1.
go back to reference Omar IM, Zoga AC, Kavanagh EC, Koulouris G, Bergin D, Gopez AG, et al. Athletic pubalgia and “sports hernia”: optimal MR imaging technique and findings. Radiographics. 2008;28(5):1415–38.CrossRefPubMed Omar IM, Zoga AC, Kavanagh EC, Koulouris G, Bergin D, Gopez AG, et al. Athletic pubalgia and “sports hernia”: optimal MR imaging technique and findings. Radiographics. 2008;28(5):1415–38.CrossRefPubMed
2.
go back to reference Zajick DC, Zoga AC, Omar IM, Meyers WC. Spectrum of MRI findings in clinical athletic pubalgia. Semin Musculoskelet Radiol. 2008;12(1):3–12.CrossRefPubMed Zajick DC, Zoga AC, Omar IM, Meyers WC. Spectrum of MRI findings in clinical athletic pubalgia. Semin Musculoskelet Radiol. 2008;12(1):3–12.CrossRefPubMed
3.
go back to reference Murphy G, Foran P, Murphy D, Tobin O, Moynagh M, Eustace S. “Superior cleft sign” as a marker of rectus abdominus/adductor longus tear in patients with suspected sportsman’s hernia. Skeletal Radiol. 2013;42(6):819–25.CrossRefPubMed Murphy G, Foran P, Murphy D, Tobin O, Moynagh M, Eustace S. “Superior cleft sign” as a marker of rectus abdominus/adductor longus tear in patients with suspected sportsman’s hernia. Skeletal Radiol. 2013;42(6):819–25.CrossRefPubMed
4.
go back to reference Khan W, Zoga AC, Meyers WC. Magnetic resonance imaging of athletic pubalgia and the sports hernia: current understanding and practice. Magn Reson Imaging Clin N Am. 2013;21(1):97–110.CrossRefPubMed Khan W, Zoga AC, Meyers WC. Magnetic resonance imaging of athletic pubalgia and the sports hernia: current understanding and practice. Magn Reson Imaging Clin N Am. 2013;21(1):97–110.CrossRefPubMed
5.
go back to reference Zoga AC, Mullens FE, Meyers WC. The spectrum of MR imaging in athletic pubalgia. Radiol Clin North Am. 2010;48(6):1179–97.CrossRefPubMed Zoga AC, Mullens FE, Meyers WC. The spectrum of MR imaging in athletic pubalgia. Radiol Clin North Am. 2010;48(6):1179–97.CrossRefPubMed
6.
go back to reference Zoga AC, Kavanagh EC, Omar IM, Morrison WB, Koulouris G, Lopez H, et al. Athletic pubalgia and the “sports hernia”: MR imaging findings. Radiology. 2008;247(3):797–807.CrossRefPubMed Zoga AC, Kavanagh EC, Omar IM, Morrison WB, Koulouris G, Lopez H, et al. Athletic pubalgia and the “sports hernia”: MR imaging findings. Radiology. 2008;247(3):797–807.CrossRefPubMed
7.
go back to reference Albers SL, Spritzer CE, Garrett Jr WE, Meyers WC. MR findings in athletes with pubalgia. Skeletal Radiol. 2001;30(5):270–7.CrossRefPubMed Albers SL, Spritzer CE, Garrett Jr WE, Meyers WC. MR findings in athletes with pubalgia. Skeletal Radiol. 2001;30(5):270–7.CrossRefPubMed
8.
go back to reference Koulouris G. Imaging review of groin pain in elite athletes: an anatomic approach to imaging findings. AJR Am J Roentgenol. 2008;191(4):962–72.CrossRefPubMed Koulouris G. Imaging review of groin pain in elite athletes: an anatomic approach to imaging findings. AJR Am J Roentgenol. 2008;191(4):962–72.CrossRefPubMed
10.
go back to reference Jacobson JA, Khoury V, Brandon CJ. Ultrasound of the groin: techniques, pathology, and pitfalls. AJR Am J Roentgenol. 2015;1–11. Jacobson JA, Khoury V, Brandon CJ. Ultrasound of the groin: techniques, pathology, and pitfalls. AJR Am J Roentgenol. 2015;1–11.
11.
go back to reference Brandon CJ, Jacobson JA, Fessell D, Dong Q, Morag Y, Girish G, et al. Groin pain beyond the hip: how anatomy predisposes to injury as visualized by musculoskeletal ultrasound and MRI. AJR Am J Roentgenol. 2011;197(5):1190–7.CrossRefPubMed Brandon CJ, Jacobson JA, Fessell D, Dong Q, Morag Y, Girish G, et al. Groin pain beyond the hip: how anatomy predisposes to injury as visualized by musculoskeletal ultrasound and MRI. AJR Am J Roentgenol. 2011;197(5):1190–7.CrossRefPubMed
12.
go back to reference Gamble JG, Simmons SC, Freedman M. The symphysis pubis: anatomic and pathologic considerations. Clin Orthop Relat Res. 1986;203:261–72.PubMed Gamble JG, Simmons SC, Freedman M. The symphysis pubis: anatomic and pathologic considerations. Clin Orthop Relat Res. 1986;203:261–72.PubMed
13.
go back to reference Cherian PT, Parnell AP. Radiologic anatomy of the inguinofemoral region: insights from MDCT. AJR Am J Roentgenol. 2007;189(4):W177–83.CrossRefPubMed Cherian PT, Parnell AP. Radiologic anatomy of the inguinofemoral region: insights from MDCT. AJR Am J Roentgenol. 2007;189(4):W177–83.CrossRefPubMed
14.
go back to reference Norton-Old KJ, Schache AG, Barker PJ, Clark RA, Harrison SM, Briggs CA. Anatomical and mechanical relationship between the proximal attachment of adductor longus and the distal rectus sheath. Clin Anat. 2013;26(4):522–30.CrossRefPubMed Norton-Old KJ, Schache AG, Barker PJ, Clark RA, Harrison SM, Briggs CA. Anatomical and mechanical relationship between the proximal attachment of adductor longus and the distal rectus sheath. Clin Anat. 2013;26(4):522–30.CrossRefPubMed
15.
go back to reference Benjamin M, Toumi H, Ralphs JR, Bydder G, Best TM, Milz S. Where tendons and ligaments meet bone: attachment sites (‘entheses’) in relation to exercise and/or mechanical load. J Anat. 2006;208(4):471–90.CrossRefPubMedPubMedCentral Benjamin M, Toumi H, Ralphs JR, Bydder G, Best TM, Milz S. Where tendons and ligaments meet bone: attachment sites (‘entheses’) in relation to exercise and/or mechanical load. J Anat. 2006;208(4):471–90.CrossRefPubMedPubMedCentral
16.
go back to reference Robinson P, Salehi F, Grainger A, Clemence M, Schilders E, O’Connor P, et al. Cadaveric and MRI study of the musculotendinous contributions to the capsule of the symphysis pubis. AJR Am J Roentgenol. 2007;188(5):W440–5.CrossRefPubMed Robinson P, Salehi F, Grainger A, Clemence M, Schilders E, O’Connor P, et al. Cadaveric and MRI study of the musculotendinous contributions to the capsule of the symphysis pubis. AJR Am J Roentgenol. 2007;188(5):W440–5.CrossRefPubMed
17.
go back to reference Jamadar DA, Robertson BL, Jacobson JA, Girish G, Sabb BJ, Jiang Y, et al. Musculoskeletal sonography: important imaging pitfalls. AJR Am J Roentgenol. 2010;194(1):216–25.CrossRefPubMed Jamadar DA, Robertson BL, Jacobson JA, Girish G, Sabb BJ, Jiang Y, et al. Musculoskeletal sonography: important imaging pitfalls. AJR Am J Roentgenol. 2010;194(1):216–25.CrossRefPubMed
18.
go back to reference Klauser AS, Peetrons P. Developments in musculoskeletal ultrasound and clinical applications. Skeletal Radiol. 2010;39(11):1061–71.CrossRefPubMed Klauser AS, Peetrons P. Developments in musculoskeletal ultrasound and clinical applications. Skeletal Radiol. 2010;39(11):1061–71.CrossRefPubMed
19.
go back to reference Orchard JW, Read JW, 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(2):134–9.CrossRefPubMedPubMedCentral Orchard JW, Read JW, 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(2):134–9.CrossRefPubMedPubMedCentral
20.
go back to reference Caudill P, Nyland J, Smith C, Yerasimides J, Lach J. Sports hernias: a systematic literature review. Br J Sports Med. 2008;42(12):954–64.CrossRefPubMed Caudill P, Nyland J, Smith C, Yerasimides J, Lach J. Sports hernias: a systematic literature review. Br J Sports Med. 2008;42(12):954–64.CrossRefPubMed
22.
go back to reference Kopelman D, Kaplan U, Hatoum OA, Abaya N, Karni D, Berber A, et al. The management of sportsman’s groin hernia in professional and amateur soccer players: a revised concept. Hernia. 2014. Kopelman D, Kaplan U, Hatoum OA, Abaya N, Karni D, Berber A, et al. The management of sportsman’s groin hernia in professional and amateur soccer players: a revised concept. Hernia. 2014.
23.
go back to reference Schilders E, Bismil Q, Robinson P, O’Connor PJ, Gibbon WW, Talbot JC. Adductor-related groin pain in competitive athletes: role of adductor enthesis, magnetic resonance imaging, and entheseal pubic cleft injections. J Bone Joint Surg Am. 2007;89(10):2173–8.CrossRefPubMed Schilders E, Bismil Q, Robinson P, O’Connor PJ, Gibbon WW, Talbot JC. Adductor-related groin pain in competitive athletes: role of adductor enthesis, magnetic resonance imaging, and entheseal pubic cleft injections. J Bone Joint Surg Am. 2007;89(10):2173–8.CrossRefPubMed
24.
go back to reference Mei-Dan O, Lopez V, Carmont MR, McConkey MO, Steinbacher G, Alvarez PD, et al. Adductor tenotomy as a treatment for groin pain in professional soccer players. Orthopedics. 2013;36(9):e1189–97.CrossRefPubMed Mei-Dan O, Lopez V, Carmont MR, McConkey MO, Steinbacher G, Alvarez PD, et al. Adductor tenotomy as a treatment for groin pain in professional soccer players. Orthopedics. 2013;36(9):e1189–97.CrossRefPubMed
25.
go back to reference Schilders E, Dimitrakopoulou A, Cooke M, Bismil Q, Cooke C. Effectiveness of a selective partial adductor release for chronic adductor-related groin pain in professional athletes. Am J Sports Med. 2013;41(3):603–7.CrossRefPubMed Schilders E, Dimitrakopoulou A, Cooke M, Bismil Q, Cooke C. Effectiveness of a selective partial adductor release for chronic adductor-related groin pain in professional athletes. Am J Sports Med. 2013;41(3):603–7.CrossRefPubMed
26.
go back to reference Brennan D, O’Connell MJ, Ryan M, Cunningham P, Taylor D, Cronin C, et al. Secondary cleft sign as a marker of injury in athletes with groin pain: MR image appearance and interpretation. Radiology. 2005;235(1):162–7.CrossRefPubMed Brennan D, O’Connell MJ, Ryan M, Cunningham P, Taylor D, Cronin C, et al. Secondary cleft sign as a marker of injury in athletes with groin pain: MR image appearance and interpretation. Radiology. 2005;235(1):162–7.CrossRefPubMed
27.
go back to reference Stensby JD, Baker JC, Fox MG. Athletic injuries of the lateral abdominal wall: review of anatomy and MR imaging appearance. Skeletal Radiol. 2015. Stensby JD, Baker JC, Fox MG. Athletic injuries of the lateral abdominal wall: review of anatomy and MR imaging appearance. Skeletal Radiol. 2015.
28.
go back to reference Garvey JF, Hazard H. Sports hernia or groin disruption injury? Chronic athletic groin pain: a retrospective study of 100 patients with long-term follow-up. Hernia. 2014;18(6):815–23.CrossRefPubMed Garvey JF, Hazard H. Sports hernia or groin disruption injury? Chronic athletic groin pain: a retrospective study of 100 patients with long-term follow-up. Hernia. 2014;18(6):815–23.CrossRefPubMed
29.
go back to reference Davies AG, Clarke AW, Gilmore J, Wotherspoon M, Connell DA. Review: imaging of groin pain in the athlete. Skeletal Radiol. 2010;39(7):629–44.CrossRefPubMed Davies AG, Clarke AW, Gilmore J, Wotherspoon M, Connell DA. Review: imaging of groin pain in the athlete. Skeletal Radiol. 2010;39(7):629–44.CrossRefPubMed
30.
go back to reference Mullens FE, Zoga AC, Morrison WB, Meyers WC. Review of MRI technique and imaging findings in athletic pubalgia and the “sports hernia”. Eur J Radiol. 2012;81(12):3780–92.CrossRefPubMed Mullens FE, Zoga AC, Morrison WB, Meyers WC. Review of MRI technique and imaging findings in athletic pubalgia and the “sports hernia”. Eur J Radiol. 2012;81(12):3780–92.CrossRefPubMed
31.
go back to reference Hiti CJ, Stevens KJ, Jamati MK, Garza D, Matheson GO. Athletic osteitis pubis. Sports Med. 2011;41(5):361–76.CrossRefPubMed Hiti CJ, Stevens KJ, Jamati MK, Garza D, Matheson GO. Athletic osteitis pubis. Sports Med. 2011;41(5):361–76.CrossRefPubMed
32.
go back to reference Gibbon WW, Hession PR. Diseases of the pubis and pubic symphysis: MR imaging appearances. AJR Am J Roentgenol. 1997;169(3):849–53.CrossRefPubMed Gibbon WW, Hession PR. Diseases of the pubis and pubic symphysis: MR imaging appearances. AJR Am J Roentgenol. 1997;169(3):849–53.CrossRefPubMed
33.
go back to reference Fitzgibbons Jr RJ, Forse RA. Clinical practice: groin hernias in adults. N Engl J Med. 2015;372(8):756–63.CrossRefPubMed Fitzgibbons Jr RJ, Forse RA. Clinical practice: groin hernias in adults. N Engl J Med. 2015;372(8):756–63.CrossRefPubMed
34.
go back to reference Jamadar DA, Jacobson JA, Morag Y, Girish G, Dong Q, Al-Hawary M, et al. Characteristic locations of inguinal region and anterior abdominal wall hernias: sonographic appearances and identification of clinical pitfalls. AJR Am J Roentgenol. 2007;188(5):1356–64.CrossRefPubMed Jamadar DA, Jacobson JA, Morag Y, Girish G, Dong Q, Al-Hawary M, et al. Characteristic locations of inguinal region and anterior abdominal wall hernias: sonographic appearances and identification of clinical pitfalls. AJR Am J Roentgenol. 2007;188(5):1356–64.CrossRefPubMed
35.
go back to reference Shadbolt CL, Heinze SB, Dietrich RB. Imaging of groin masses: inguinal anatomy and pathologic conditions revisited. Radiographics. 2001; 21 Suppl1:S261–271. Shadbolt CL, Heinze SB, Dietrich RB. Imaging of groin masses: inguinal anatomy and pathologic conditions revisited. Radiographics. 2001; 21 Suppl1:S261–271.
36.
go back to reference Jamadar DA, Jacobson JA, Morag Y, Girish G, Ebrahim F, Gest T, et al. Sonography of inguinal region hernias. AJR Am J Roentgenol. 2006;187(1):185–90.CrossRefPubMed Jamadar DA, Jacobson JA, Morag Y, Girish G, Ebrahim F, Gest T, et al. Sonography of inguinal region hernias. AJR Am J Roentgenol. 2006;187(1):185–90.CrossRefPubMed
37.
go back to reference Troelsen A, Mechlenburg I, Gelineck J, Bolvig L, Jacobsen S, Soballe K. What is the role of clinical tests and ultrasound in acetabular labral tear diagnostics? Acta Orthop. 2009;80(3):314–8.CrossRefPubMedPubMedCentral Troelsen A, Mechlenburg I, Gelineck J, Bolvig L, Jacobsen S, Soballe K. What is the role of clinical tests and ultrasound in acetabular labral tear diagnostics? Acta Orthop. 2009;80(3):314–8.CrossRefPubMedPubMedCentral
38.
go back to reference Mervak BM, Morag Y, Marcantonio D, Jacobson J, Brandon C, Fessell D. Paralabral cysts of the hip: sonographic evaluation with magnetic resonance arthrographic correlation. J Ultrasound Med. 2012;31(3):495–500.PubMed Mervak BM, Morag Y, Marcantonio D, Jacobson J, Brandon C, Fessell D. Paralabral cysts of the hip: sonographic evaluation with magnetic resonance arthrographic correlation. J Ultrasound Med. 2012;31(3):495–500.PubMed
39.
go back to reference Jin W, Kim KI, Rhyu KH, Park SY, Kim HC, Yang DM, et al. Sonographic evaluation of anterosuperior hip labral tears with magnetic resonance arthrographic and surgical correlation. J Ultrasound Med. 2012;31(3):439–47.PubMed Jin W, Kim KI, Rhyu KH, Park SY, Kim HC, Yang DM, et al. Sonographic evaluation of anterosuperior hip labral tears with magnetic resonance arthrographic and surgical correlation. J Ultrasound Med. 2012;31(3):439–47.PubMed
40.
go back to reference O’Connell MJ, Powell T, McCaffrey NM, O’Connell D, Eustace SJ. Symphyseal cleft injection in the diagnosis and treatment of osteitis pubis in athletes. AJR Am J Roentgenol. 2002;179(4):955–9.CrossRefPubMed O’Connell MJ, Powell T, McCaffrey NM, O’Connell D, Eustace SJ. Symphyseal cleft injection in the diagnosis and treatment of osteitis pubis in athletes. AJR Am J Roentgenol. 2002;179(4):955–9.CrossRefPubMed
41.
go back to reference Scholten PM, Massimi S, Dahmen N, Diamond J, Wyss J. Successful treatment of athletic pubalgia in a lacrosse player with ultrasound-guided needle tenotomy and platelet-rich plasma injection: a case report. PM R. 2015;7(1):79–83.CrossRefPubMed Scholten PM, Massimi S, Dahmen N, Diamond J, Wyss J. Successful treatment of athletic pubalgia in a lacrosse player with ultrasound-guided needle tenotomy and platelet-rich plasma injection: a case report. PM R. 2015;7(1):79–83.CrossRefPubMed
42.
go back to reference Choi H, McCartney M, Best TM. Treatment of osteitis pubis and osteomyelitis of the pubic symphysis in athletes: a systematic review. Br J Sports Med. 2011;45(1):57–64.CrossRefPubMedPubMedCentral Choi H, McCartney M, Best TM. Treatment of osteitis pubis and osteomyelitis of the pubic symphysis in athletes: a systematic review. Br J Sports Med. 2011;45(1):57–64.CrossRefPubMedPubMedCentral
43.
go back to reference Topol GA, Reeves KD, Hassanein KM. Efficacy of dextrose prolotherapy in elite male kicking-sport athletes with chronic groin pain. Arch Phys Med Rehabil. 2005;86(4):697–702.CrossRefPubMed Topol GA, Reeves KD, Hassanein KM. Efficacy of dextrose prolotherapy in elite male kicking-sport athletes with chronic groin pain. Arch Phys Med Rehabil. 2005;86(4):697–702.CrossRefPubMed
Metadata
Title
Sonographic evaluation of athletic pubalgia
Authors
Nicholas Morley
Thomas Grant
Kevin Blount
Imran Omar
Publication date
01-05-2016
Publisher
Springer Berlin Heidelberg
Published in
Skeletal Radiology / Issue 5/2016
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-016-2340-8

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