Abstract
Hip and groin pain is a frequent complaint among competitive athletes. Effect of groin pain on athletic performance ranges from intermittent discomfort to severe and chronic career-threatening pain. Since it may be detected in wide variety of sport branches, physicians should be aware of numerous mechanisms of injuries. Management of groin pain remains challenging for clinicians because of its complex nature and broad range of underlying etiology. Therefore, excluding irrelevant causes of groin pain require meticulous effort for each individual. High recurrence rate and negative impact on athletic activity level of the groin pain should always be kept in mind and treatment algorithm must be started immediately to avoid undesired outcomes.
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References
Meeuwisse WH, et al. A dynamic model of etiology in sport injury: the recursive nature of risk and causation. Clin J Sport Med. 2007;17(3):215–9.
Ekstrand J, Hagglund M, Walden M. Injury incidence and injury patterns in professional football: the UEFA injury study. Br J Sports Med. 2011;45(7):553–8.
Cugat R, et al. Common reasons of groin Pain Groin pain in sports. In: Sports injuries. Oxford: Oxford University Press; 2014. p. 1–18.
Hawkins RD, et al. The association football medical research programme: an audit of injuries in professional football. Br J Sports Med. 2001;35(1):43–7.
Weir A, et al. Doha agreement meeting on terminology and definitions in groin pain in athletes. Br J Sports Med. 2015;49(12):768–74.
Werner J, et al. UEFA injury study: a prospective study of hip and groin injuries in professional football over seven consecutive seasons. Br J Sports Med. 2009;43(13):1036–40.
McSweeney SE, et al. Hip and groin pain in the professional athlete. Can Assoc Radiol J. 2012;63(2):87–99.
Whittaker JL, et al. Risk factors for groin injury in sport: an updated systematic review. Br J Sports Med. 2015;49(12):803–9.
Hagglund M, Walden M, Ekstrand J. Previous injury as a risk factor for injury in elite football: a prospective study over two consecutive seasons. Br J Sports Med. 2006;40(9):767–72.
Winston P, et al. Clinical examination and ultrasound of self-reported snapping hip syndrome in elite ballet dancers. Am J Sports Med. 2007;35(1):118–26.
Domb BG, Brooks AG, Byrd J. Clinical examination of the hip joint in athletes. J Sport Rehabil. 2009;18(1):3–23.
Martin HD, et al. The pattern and technique in the clinical evaluation of the adult hip: the common physical examination tests of hip specialists. Arthroscopy. 2010;26(2):161–72.
Livingston LA, Stevenson JM, Olney SJ. Stairclimbing kinematics on stairs of differing dimensions. Arch Phys Med Rehabil. 1991;72(6):398–402.
Drew MK, et al. Resisted adduction in hip neutral is a superior provocation test to assess adductor longus pain: an experimental pain study. Scand J Med Sci Sports. 2016;26(8):967–74.
Reiman MP, et al. Diagnostic accuracy of clinical tests of the hip: a systematic review with meta-analysis. Br J Sports Med. 2013;47(14):893–902.
McCarthy JC, Busconi B. The role of hip arthroscopy in the diagnosis and treatment of hip disease. Orthopedics. 1995;18(8):753–6.
Hananouchi T, et al. Anterior impingement test for labral lesions has high positive predictive value. Clin Orthop Relat Res. 2012;470(12):3524–9.
Troelsen A, et al. What is the role of clinical tests and ultrasound in acetabular labral tear diagnostics? Acta Orthop. 2009;80(3):314–8.
Kalisvaart MM, Safran MR. Microinstability of the hip-it does exist: etiology, diagnosis and treatment. J Hip Preserv Surg. 2015;2(2):123–35.
Philippon MJ, et al. Revision hip arthroscopy. Am J Sports Med. 2007;35(11):1918–21.
Hoppe DJ, et al. Diagnostic accuracy of 3 physical examination tests in the assessment of hip microinstability. Orthop J Sports Med. 2017;5(11):2325967117740121.
Maslowski E, et al. The diagnostic validity of hip provocation maneuvers to detect intra-articular hip pathology. PM R. 2010;2(3):174–81.
Pacheco-Carrillo A, Medina-Porqueres I. Physical examination tests for the diagnosis of femoroacetabular impingement. A systematic review. Phys Ther Sport. 2016;21:87–93.
Reiman MP, Thorborg K. Clinical examination and physical assessment of hip joint-related pain in athletes. Int J Sports Phys Ther. 2014;9(6):737.
Mitchell B, et al. Hip joint pathology: clinical presentation and correlation between magnetic resonance arthrography, ultrasound, and arthroscopic findings in 25 consecutive cases. Clin J Sport Med. 2003;13(3):152–6.
Bharam S. Labral tears, extra-articular injuries, and hip arthroscopy in the athlete. Clin Sports Med. 2006;25(2):279–92.
Elattar O, et al. Groin injuries (athletic Pubalgia) and return to play. Sports Health. 2016;8(4):313–23.
Flemming DJ, Walker EA. Imaging of hip and pelvis injuries. In: The hip and pelvis in sports medicine and primary care. Cham: Springer International Publishing; 2010. p. 87–113.
Mei-Dan O, et al. Normal anatomy and imaging of the hip: emphasis on impingement assessment. Semin Musculoskelet Radiol. 2013;17(03):229–47.
Lim S-J, Park Y-S. Plain radiography of the hip: a review of radiographic techniques and image features. Hip & Pelvis. 2015;27(3):125–34.
Hananouchi T, et al. Preoperative templating of femoral components on plain X-rays. Rotational evaluation with synthetic X-rays on ORTHODOC. Arch Orthop Trauma Surg. 2007;127(5):381–5.
Matheson GO, et al. Stress fractures in athletes:a study of 320 cases. Am J Sports Med. 1987;15(1):46–58.
Fredericson M, et al. Stress fractures in athletes. Top Magn Reson Imaging. 2006;17(5):309–25.
Tannast M, et al. Which radiographic hip parameters do not have to be corrected for pelvic rotation and tilt? Clin Orthop Relat Res. 2015;473(4):1255–66.
Smith KM, et al. Comparison of MRI, CT, Dunn 45 degrees and Dunn 90 degrees alpha angle measurements in femoroacetabular impingement. Hip Int. 2017;28(4):450–5.
Barrientos C, et al. Is there a pathological alpha angle for hip impingement? A diagnostic test study. J Hip Preserv Surg. 2016;3(3):223–8.
Beaule P, et al. Three-dimensional computed tomography of the hip in the assessment of femoroacetabular impingement. J Orthop Res. 2005;23(6):1286–92.
Peters CL, et al. Hip-preserving surgery: understanding complex pathomorphology. J Bone Joint Surg Am. 2009;91(Suppl 6):42–58.
Bedi A, et al. Computer-assisted modeling of osseous impingement and resection in femoroacetabular impingement. Arthroscopy. 2012;28(2):204–10.
Campbell R. Ultrasound of the athletic groin. Semin Musculoskelet Radiol. 2013;17(1):34–42.
Byrd JW, et al. Ultrasound-guided hip injections: a comparative study with fluoroscopy-guided injections. Arthroscopy. 2014;30(1):42–6.
Mintz DN, et al. Magnetic resonance imaging of the hip: detection of labral and chondral abnormalities using noncontrast imaging. Arthroscopy. 2005;21(4):385–93.
Nelson EN, Kassarjian A, Palmer WE. MR imaging of sports-related groin pain. Magn Reson Imaging Clin N Am. 2005;13(4):727–42.
de Sa D, et al. Athletic groin pain: a systematic review of surgical diagnoses, investigations and treatment. Br J Sports Med. 2016;50(19):1181–6.
Gold GE, et al. Recent advances in MRI of articular cartilage. AJR Am J Roentgenol. 2009;193(3):628–38.
Hesper T, et al. T2*-mapping of Acetabular cartilage in patients with Femoroacetabular impingement at 3 tesla: comparative analysis with arthroscopic findings. Cartilage. 2017;9(2):118–26. https://doi.org/10.1177/1947603517741168.
Jazrawi LM, Alaia MJ, Chang G, Fitzgerald EF, Recht MP. Advances in magnetic resonance imaging of articular cartilage. Am Acad Orthop Surg. 2011;19(7):420–9.
Ellermann J, et al. Acetabular cartilage assessment in patients with Femoroacetabular impingement by using T2* mapping with arthroscopic verification. Radiology. 2014;271(2):512–23.
Bittersohl B, et al. Delayed gadolinium-enhanced magnetic resonance imaging of hip joint cartilage: pearls and pitfalls. Orthop Rev (Pavia). 2011;3(2):e11.
Bittersohl B, et al. Cartilage damage in femoroacetabular impingement (FAI): preliminary results on comparison of standard diagnostic vs delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC). Osteoarthr Cartil. 2009;17(10):1297–306.
Bittersohl B, et al. Advanced imaging in Femoroacetabular impingement: current state and future prospects. Front Surg. 2015;2:34.
de Sa D, et al. Extra-articular hip impingement: a systematic review examining operative treatment of psoas, subspine, ischiofemoral, and greater trochanteric/pelvic impingement. Arthroscopy. 2014;30(8):1026–41.
Kiuru MJ, et al. Bone stress injuries in asymptomatic elite recruits: a clinical and magnetic resonance imaging study. Am J Sports Med. 2005;33(2):272–6.
DeFranco MJ, et al. Stress fractures of the femur in athletes. Clin Sports Med. 2006;25(1):89–103.
Harrast MA, Colonno D. Stress fractures in runners. Clin Sports Med. 2010;29(3):399–416.
Huffman GR, Safran M. Tears of the acetabular labrum in athletes: diagnosis and treatment. Sports Med Arthrosc Rev. 2002;10(2):141–50.
Mason JB. Acetabular labral tears in the athlete. Clin Sports Med. 2001;20(4):779–90.
Keeney JA, et al. Magnetic resonance arthrography versus arthroscopy in the evaluation of articular hip pathology. Clin Orthop Relat Res. 2004;429:163–9.
Tian C-Y, et al. 3.0 T conventional hip MR and hip MR arthrography for the acetabular labral tears confirmed by arthroscopy. Eur J Radiol. 2014;83(10):1822–7.
Armfield DR, Towers JD, Robertson DD. Radiographic and MR imaging of the athletic hip. Clin Sports Med. 2006;25(2):211–39.
Gallo RA, et al. Asymptomatic hip/groin pathology identified on magnetic resonance imaging of professional hockey players: outcomes and playing status at 4 years’ follow-up. Arthroscopy. 2014;30(10):1222–8.
Agten CA, et al. Hip imaging in athletes: sports imaging series. Radiology. 2016;280(2):351–69.
Gray AJ, Villar RN. The ligamentum teres of the hip: an arthroscopic classification of its pathology. Arthroscopy. 1997;13(5):575–8.
Botser IB, et al. Tears of the ligamentum teres: prevalence in hip arthroscopy using 2 classification systems. Am J Sports Med. 2011;39(Suppl):117S–25S.
Datir A, et al. Diagnostic utility of MRI and MR arthrography for detection of ligamentum teres tears: a retrospective analysis of 187 patients with hip pain. AJR Am J Roentgenol. 2014;203(2):418–23.
Byrd JW, Jones KS. Diagnostic accuracy of clinical assessment, magnetic resonance imaging, magnetic resonance arthrography, and intra-articular injection in hip arthroscopy patients. Am J Sports Med. 2004;32(7):1668–74.
Ekstrand J, et al. Hamstring muscle injuries in professional football: the correlation of MRI findings with return to play. Br J Sports Med. 2012;46(2):112–7.
Peetrons P. Ultrasound of muscles. Eur Radiol. 2002;12(1):35–43.
Sherry MA, Johnston TS, Heiderscheit BC. Rehabilitation of acute hamstring strain injuries. Clin Sports Med. 2015;34(2):263–84.
De Smet AA, Best TM. MR imaging of the distribution and location of acute hamstring injuries in athletes. Am J Roentgenol. 2000;174(2):393–9.
Schneider-Kolsky ME, et al. A comparison between clinical assessment and magnetic resonance imaging of acute hamstring injuries. Am J Sports Med. 2006;34(6):1008–15.
Crema MD, et al. Hamstring injuries in professional soccer players: extent of MRI-detected edema and the time to return to play. Sports Health. 2018;10(1):75–9.
Pollock N, et al. British athletics muscle injury classification: a new grading system. Br J Sports Med. 2014;48(18):1347–51.
Noonan TJ, Garrett WE Jr. Muscle strain injury: diagnosis and treatment. J Am Acad Orthop Surg. 1999;7(4):262–9.
Shimba LG, et al. Surgical treatment of rectus femoris injury in soccer playing athletes: report of two cases. Rev Bras Ortop. 2017;52(6):743–7.
Mariluisa CA, Cupitob J, Mamone F. Muscle injuries of the rectus femoris muscle. MR update. Rev Argent Radiol. 2015;79(4):182–91.
Meyers WC, et al. Understanding “sports hernia”(athletic pubalgia): the anatomic and pathophysiologic basis for abdominal and groin pain in athletes. Oper Tech Sports Med. 2012;20(1):33–45.
Brennan D, 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.
Zoga AC, et al. Athletic pubalgia and the “sports hernia”: MR imaging findings. Radiology. 2008;247(3):797–807.
Hiti CJ, et al. Athletic osteitis pubis. Sports Med. 2011;41(5):361–76.
Michalski M, Engebretsen L. Bone and joint problems related to groin pain. In: Doral MN, Karlsson J, editors. Sports Injuries: Prevention, Diagnosis, Treatment and Rehabilitation. Berlin: Springer; 2015. p. 1–22.
Beatty T. Osteitis pubis in athletes. Curr Sports Med Rep. 2012;11(2):96–8.
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Cırdı, Y.U., Ergün, S., Karahan, M. (2019). Physical Examination and Imaging of the Painful Athletic Hip. In: Safran, M., Karahan, M. (eds) Hip and Groin Pain in the Athlete . Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-58699-0_1
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