The Role of Pubic Symphyseal CT Arthrography in the Imaging of Athletic Pubalgia

McArthur, Tatum A.; Narducci, Carl A.; Lopez‐Ben, Robert

doi:10.2214/ajr.13.12050

Cited by 10 publications

(8 citation statements)

References 19 publications

(14 reference statements)

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“…106,112 Recent data from a small sample (n = 12) suggests that computed tomography arthrography after direct pubic symphysis injection may be more sensitive than MRI for detecting adductor tendon tears and reactive changes in the pubic body. 113 Neuropathy of the femoral, obturator, ilioinguinal, and genitofemoral nerves may cause anterior hip pain. The femoral nerve stretch test is a neurodynamic maneuver used for detection of a neuropathy.…”

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confidence: 99%

Posterior, Lateral, and Anterior Hip Pain Due to Musculoskeletal Origin: A Narrative Literature Review of History, Physical Examination, and Diagnostic Imaging

Battaglia

D’Angelo

Kettner

2016

Journal of Chiropractic Medicine

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Objective: The purpose of this study was to present a narrative review of the literature of musculoskeletal causes of adult hip pain, with special attention to history, physical examination, and diagnostic imaging. Methods: A narrative review of the English medical literature was performed by using the search terms "hip pain" AND "anterior," "lateral," and "posterior." Additionally, specific entities of hip pain or pain referral sources to the hip were searched for. We used the PubMed search engine through January 15, 2016. Results: Musculoskeletal sources of adult hip pain can be divided into posterior, lateral, and anterior categories. For posterior hip pain, select considerations include lumbar spine and femoroacetabular joint referral, sacroiliac joint pathology, piriformis syndrome, and proximal hamstring tendinopathy. Gluteal tendinopathy and iliotibial band thickening are the most common causes of lateral hip pain. Anterior hip pain is further divided into causes that are intra-articular (ie, labral tear, osteoarthritis, osteonecrosis) and extra-articular (ie, snapping hip and inguinal disruption [athletic pubalgia]). Entrapment neuropathies and myofascial pain should also be considered in each compartment. A limited number of historical features and physical examination tests for evaluation of adult hip pain are supported by the literature and are discussed in this article. Depending on the clinical differential, the gamut of diagnostic imaging modalities recommended for accurate diagnosis include plain film radiography, computed tomography, magnetic resonance imaging, skeletal scintigraphy, and ultrasonography. Conclusions: The evaluation of adult hip pain is challenging. Clinicians should consider posterior, lateral, and anterior sources of pain while keeping in mind that these may overlap. (J Chiropr Med 2016;15:281-293)

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confidence: 99%

Posterior, Lateral, and Anterior Hip Pain Due to Musculoskeletal Origin: A Narrative Literature Review of History, Physical Examination, and Diagnostic Imaging

Battaglia

D’Angelo

Kettner

2016

Journal of Chiropractic Medicine

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“…Radiographs of the pelvis and hip are an important first step to evaluate the osseous structures and to rule out other diagnoses in the differential 21 . Ultrasound and computed tomography (CT) may also be used to show an inguinal bulge that is not appreciated on examination [21][22][23] . Magnetic resonance imaging (MRI) remains the primary tool in diagnosis, as it is able to rule out or to identify associated pathologies.…”

Section: Imagingmentioning

confidence: 99%

“…CT arthrography with injection into the pubic symphyseal fibrocartilaginous disc may elucidate tears of the rectus or adductors not appreciated by MRI 23 . CT arthrography may be therapeutic, in relieving groin pain, as well as diagnostic.…”

Section: Imagingmentioning

confidence: 99%

Sports Hernia: Definition, Evaluation, and Treatment

Hopkins

Brown²,

Lee

2017

JBJS Rev

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Sports hernia is a non-anatomic, non-diagnostic term that has been attributed to many different causes of groin pain. » Sports hernia is better described as pain localized anatomically to the inguinal region of an athlete without an actual hernia.» Nonoperative management including core stability while avoiding extreme hip range of motion should be attempted for at least 2 months prior to any operative intervention.» Associated pathology such as femoroacetabular impingement or adductor tear should be addressed. » If a sports hernia is not responsive to rehabilitation, referral to a general surgeon is appropriate.

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“…In patients with athletic pubalgia, a dedicated MR imaging examination should be performed with a small field of view and fluid-sensitive axial oblique and sagittal images centered on the pubic symphysis (7). The superiority of computed tomographic (CT) arthrography in the delineation of secondary clefts and tendon tears has been demonstrated in some studies (8). However, we do not routinely perform this procedure because of patient discomfort and because conservative treatment is the mainstay of therapy, with surgical intervention rarely being necessary (5,9).…”

Section: Teaching Pointsmentioning

confidence: 99%

Imaging of Sports-related Injuries of the Lower Extremity in Pediatric Patients

O’Dell¹,

Jaramillo²,

Bancroft³

et al. 2016

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With increasing participation and intensity of training in youth sports in the United States, the incidence of sports-related injuries is increasing, and the types of injuries are shifting. In this article, the authors review sports injuries of the lower extremity, including both acute and overuse injuries, that are common in or specific to the pediatric population. Common traumatic injuries that occur in individuals of all ages (eg, tears of the acetabular labrum and anterior cruciate ligament) are not addressed, although these occur routinely in pediatric sports. However, some injuries that occur almost exclusively in high-level athletes (eg, athletic pubalgia) are reviewed to increase awareness and understanding of these entities among pediatric radiologists who may not be familiar with them and thus may not look for them. Injuries are described according to their location (ie, hip, knee, or foot and ankle) and pathologic process (eg, apophysitis, osteochondritis dissecans). Examples of abnormalities and normal variants of the anatomy that are often misdiagnosed are provided. The injuries reviewed represent a common and growing subset of pathologic processes about which all pediatric and musculoskeletal radiologists should be knowledgeable. Understanding physeal injury is especially important because missed diagnoses can lead to premature physeal closure and osteoarthritis. RSNA, 2016.

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The Role of Pubic Symphyseal CT Arthrography in the Imaging of Athletic Pubalgia

Abstract: Pubic symphyseal CT arthrography is a useful technique for the diagnosis and short-term pain relief of athletic pubalgia. It can be used to identify secondary clefts and to detect tendon tears that can potentially be overlooked on MRI.

Cited by 10 publications

References 19 publications

Posterior, Lateral, and Anterior Hip Pain Due to Musculoskeletal Origin: A Narrative Literature Review of History, Physical Examination, and Diagnostic Imaging

Posterior, Lateral, and Anterior Hip Pain Due to Musculoskeletal Origin: A Narrative Literature Review of History, Physical Examination, and Diagnostic Imaging

Sports Hernia: Definition, Evaluation, and Treatment

Imaging of Sports-related Injuries of the Lower Extremity in Pediatric Patients

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