Table 3

Radiographic and ultrasonographic studies

StudyHarris and Murray (1974)Fricker et al(1991)Major and Helms (1997)Besjakov et al(2003)Kälebo et al(1992)
Case-study group participants (incl. sports type, gender, age)Group 1: 26 athletes (soccer)
Group 2: 11 athletes (9 soccer, 1 jockey, 1 runner)
59 patients (28 running, 8 soccer, 8 ice hockey & others)
50 male, 9 female. Age 13–61
44 male & 4 female performing sports
11 athletes (7 runners, 1 soccer, 3 basketball)
9 male, 2 female. Age 20–60
20 athletes (17 soccer, 2 handball, 1 ice hockey)
Male. Age 19–35
36 patients
28 male, 8 female. Age 14–57
Controls156 controls of whom some athletic (number unknown)
Male, Age 17–18
None20 controls
11 male, 9 female. Age 18–72
Group 1: 20 men
Group 2: 120 adults (66 males, 54 females) Age 15–90
Same patients : Ultrasonography of the contralateral asymptomatic side
Inclusion criteriaGroup 1: athletes from same professional soccer team (1 with groin pain)
Group 2: athletes with history of groin/lower abdominal pain
Patients with osteitis pubis (clinical signs and positive radiographic or isotope bone scan findings)Cases: groin and/or lower back pain (sciatica)
Controls: Asymptomatic
Cases: Uni or bilat groin pain for >3 months
Control 1: age-matched men without symptoms, level of physical activity unknown
Control 2: Not described
Pain and weakness in groin area during physical activity
Exclusion criteriaNot describedNot describedNot describedControl 1: History of sports injury, urologic complaint, or other pelvic conditionNot described
Clinical findings (1) type of examination (2) findingsNone(1) Not described
(2) 70% have tenderness at pubic symphysis, 42% adductor-related pain,
(1) Not described
(2) All cases have tenderness on palpation of pubic symphysis
None(1) Not reproducible but details given
(2) All cases have unilateral pain (9 adductor-related, 13 hamstrings, 5 rectus femoris, 4 gluteal muscle, 2 rectus abdominis)
Radiology protocol

Group 1–2: Plain PA pelvic view close to the symphysis with pt standing on each leg (2) x-rays)
Controls: Pelvic AP supine
Not described
Radiographs (number unknown)
Plain pelvic AP films (not defined if supine or standing)For all patients: Plain pelvic films in supine position and additional posistions if necessary7,5 MHz linear array transducer
Examiner not described
Additional radiological examinationsNoneIsotope bone scans (number unknown)4 cases CT, 2 cases MRI and 3 cases bone scanNonePlain radiography to exclude avulsion fractures
Evaluation of imagesGroup 1–2:
(1) Abnormal width of symphyseal cleft (>1 cm), marginal irregularity, reactive sclerosis
(2) Instability on stress films (difference in height of superior pubic rami >2 mm)
(3)accentuation of origins of gracilis muscle
Controls: instability not assessed due to lack og stress films
1 Radiologist blinded to clinical symptoms
(1) Radiographs: symphyseal changes. Uni/bilateral. Pubic instability on stress films
(2) Isotope bone scans: normal, mild, moderate or marked increased isotope uptake. Uni/bilateral.
Presence of obliteration of the symphyseal cleft.
Not described2 Radiologists
Changes divided into 4 groups according to grading scale (no bone changes/slight/intermediate/advanced changes) classifying visible changes in the pubic bones and symphysis
Proximal tendons and tendomuscular junctions of recus femoris, rectus abdominis, adductor muscles, hamstring muscles and gluteal muscles
Tendons scanned longitudinally and transversely to identify lesions
Reproducibility of radiologyNoneNoneNoneInterobserver agreementNone
‘Gold standard” usedNoneNoneNoneNoneSurgery in 10 patients
Conclusions/resultsGroup 1: abnormalities in 76%
Group 2: abnormalities in 81%
Controls: abnormalities in 45%
Males: 38% with unilateral and 63% with bilateral pain show corresponding positive isotope bone scans. 38% with unilateral and 43% with bilateral pain show corresponding positive radiographic changes.
Women with unilateral pain show no matching and women with bilateral pain show 100% matching with radiological findings
Cases: All cases have erosions, areas of sclerosis or offset at pubic symphysis.
4 cases: Avulsion of inferior part of symphysis
Controls: 6 ptts over age 55 have mild sclerosis at pubic symphysis
Cases: 9 slight, 9 intermediate, 2 advanced changes
Control 1: 3 none,17 slight changes
Control 2: 40(42) none, 65 (64) slight, 15(14) intermediate
Increase of abnormalities with age in control group 2
28 of 36 cases have tendon lesions at the corresponding painful areas.
Location: 12 in proximal tendon, 11 in tendomuscular junction and 5 in tendon-bone junction
9 of 10 surgically treated cases: findings similar to ultrasound