Athletic Pubalgia and “Sports Hernia”: Optimal MR Imaging Technique and Findings

Abstract

Groin injuries are common in athletes who participate in sports that require twisting at the waist, sudden and sharp changes in direction, and side-to-side ambulation. Such injuries frequently lead to debilitating pain and lost playing time, and they may be difficult to diagnose. Diagnostic confusion often arises from the complex anatomy and biomechanics of the pubic symphysis region, the large number of potential sources of groin pain, and the similarity of symptoms in athletes with different types or sites of injury. Many athletes with a diagnosis of "sports hernia" or "athletic pubalgia" have a spectrum of related pathologic conditions resulting from musculotendinous injuries and subsequent instability of the pubic symphysis without any finding of inguinal hernia at physical examination. The actual causal mechanisms of athletic pubalgia are poorly understood, and imaging studies have been deemed inadequate or unhelpful for clarification. However, a large-field-of-view magnetic resonance (MR) imaging survey of the pelvis, combined with high-resolution MR imaging of the pubic symphysis, is an excellent means of assessing various causes of athletic pubalgia, providing information about the location of injury, and delineating the severity of disease. Familiarity with the pubic anatomy and with MR imaging findings in athletic pubalgia and in other confounding causes of groin pain allows accurate imaging-based diagnoses and helps in planning treatment that targets specific pathologic conditions.

Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal Hernia [International Endohernia Society (IEHS)]

“…Dulucq et al [29] showed acceptable complication and recurrence rates after TEP repair in 3,100 patients. During TAPP repair, there is an advantage of diagnosing and repairing unexpected contralateral hernias in patients with unilateral hernias, which has been reported to occur in 25-50% of patients [47,48].…”

“…Quite often, substantial funicular lipomas or pre-/or retroperitoneal fat prolapse into the enlarged hernia orifices ring [45][46][47][48]. They should be retracted and eventually resected, because they may become symptomatic or mimic a recurrent hernia [49].…”

“…In the current literature on endoscopic groin hernia repair, insufficient or no data are available about the relationship between pain and the management of strangulated and incarcerated hernias, port defects, scrotal hernias, and cord lipomas. Although several publications have reported on pain and nerve management in open groin hernia surgery [48][49][50][51][52][53], no data are available on nerve manipulation and pain in endoscopic hernia repair. …”

Ultrasound for the evaluation of femoroacetabular impingement of the cam type. Diagnostic performance of qualitative criteria and alpha angle measurements

“…Groin pain is a very early complaint of patients suffering from FAI but its differential diagnosis is very wide: stress fractures of the femoral neck, iliopsoas tendonitis, tears of the adductor tendons, nerve entrapment syndromes and inguinal hernia are only a few of the possible underlying conditions leading to groin pain, especially in athletes [18]. Therefore, a history of groin pain is an early, but non-specific finding of FAI.…”

Osteitis pubis in elite athletes: Diagnostic and therapeutic approach

“…It consists of appropriately oriented weight bearing anteroposterior (AP) pelvis, a Dunn lateral, and a false profile view [3] . It may depict subchondral sclerosis, symphyseal lytic changes and widening or narrowing of the joint space, especially in the chronic phase of the disease [18,32,33] . Another proposed radiographic view, with major contribution to the pubic instability evaluation is the flamingo view in double and single leg stance positions [11,34] .…”