Semin Musculoskelet Radiol 2011; 15(1): 003-013
DOI: 10.1055/s-0031-1271955
© Thieme Medical Publishers

Groin Pain: Clinical Assessment and the Role of MR Imaging

Gonzalo Ansede1 , Bryan English2 , Jeremiah C. Healy1 , 3
  • 1Radiology Department, Chelsea and Westminster Hospital, London, United Kingdom
  • 2Chelsea Football Club, London, United Kingdom
  • 3Imperial College, London, United Kingdom
Further Information

Publication History

Publication Date:
17 February 2011 (online)

ABSTRACT

Groin pain is a common problem in the elite athlete and may lead to prolonged inactivity if inadequately treated. Groin pain, arising from injuries to the hip and pelvis, accounts for 5 to 6% of athletic injuries in adults and 10 to 24% of these injuries in children. Lower limb–dominated athletic activities such as football, rugby, ice hockey, running, and ballet are particularly at risk. Comprehensive evaluation of all the anatomical locations prone to injury including the hip joint, sacrum, ilium and proximal femora, pelvic tendon attachments, and pelvic musculature is required. Magnetic resonance (MR) imaging provides superb soft tissue contrast resolution, multiplanar capabilities, and a wide field of view to evaluate many potential causes of groin pain. Careful clinical examination allows the optimal use of MR imaging and MR arthrography to evaluate the articular, osseous, tendinous, and muscular structures, which may be the source of groin pain. Accurate diagnosis is essential for appropriate management and rehabilitation plans. This article reviews the role of clinical assessment in guiding diagnostic imaging and also describes the relevant MR imaging findings in athletes presenting with groin pain.

REFERENCES

  • 1 Bencardino J T, Palmer W E. Imaging of hip disorders in athletes.  Radiol Clin North Am. 2002;  40 (2) 267-287, vi–vii
  • 2 Schulte-Altedorneburg G, Gebhard M, Wohlgemuth W A et al.. MR arthrography: pharmacology, efficacy and safety in clinical trials.  Skeletal Radiol. 2003;  32(1) 1-12
  • 3 Tibor L M, Sekiya J K. Differential diagnosis of pain around the hip joint.  Arthroscopy. 2008;  24(12) 1407-1421
  • 4 Berndt A L, Harty M. Transchondral fractures (osteochondritis dissecans) of the talus.  J Bone Joint Surg Am. 1959;  41-A(Suppl A) 988-1020
  • 5 Weaver C J, Major N M, Garrett W E, Urbaniak J E. Femoral head osteochondral lesions in painful hips of athletes: MR imaging findings.  AJR Am J Roentgenol. 2002;  178(4) 973-977
  • 6 Kopecky K K, Braunstein E M, Brandt K D et al.. Apparent avascular necrosis of the hip: appearance and spontaneous resolution of MR findings in renal allograft recipients.  Radiology. 1991;  179(2) 523-527
  • 7 Mink J H, Deutsch A L. Occult cartilage and bone injuries of the knee: detection, classification, and assessment with MR imaging.  Radiology. 1989;  170(3 Pt 1) 823-829
  • 8 Vellet A D, Marks P H, Fowler P J, Munro T G. Occult posttraumatic osteochondral lesions of the knee: prevalence, classification, and short-term sequelae evaluated with MR imaging.  Radiology. 1991;  178(1) 271-276
  • 9 De Smet A A, Fisher D R, Burnstein M I, Graf B K, Lange R H. Value of MR imaging in staging osteochondral lesions of the talus (osteochondritis dissecans): results in 14 patients.  AJR Am J Roentgenol. 1990;  154(3) 555-558
  • 10 Seldes R M, Tan V, Hunt J, Katz M, Winiarsky R, Fitzgerald Jr R H. Anatomy, histologic features, and vascularity of the adult acetabular labrum.  Clin Orthop Relat Res. 2001;  382(382) 232-240
  • 11 McCarthy J C, Noble P C, Schuck M R, Wright J, Lee J. The Otto E. Aufranc Award: the role of labral lesions to development of early degenerative hip disease.  Clin Orthop Relat Res. 2001;  393(393) 25-37
  • 12 Keene G S, Villar R N. Arthroscopic anatomy of the hip: an in vivo study.  Arthroscopy. 1994;  10(4) 392-399
  • 13 Czerny C, Hofmann S, Urban M et al.. MR arthrography of the adult acetabular capsular-labral complex: correlation with surgery and anatomy.  AJR Am J Roentgenol. 1999;  173(2) 345-349
  • 14 Cotten A, Boutry N, Demondion X et al.. Acetabular labrum: MRI in asymptomatic volunteers.  J Comput Assist Tomogr. 1998;  22(1) 1-7
  • 15 Lecouvet F E, Vande Berg B C, Malghem J et al.. MR imaging of the acetabular labrum: variations in 200 asymptomatic hips.  AJR Am J Roentgenol. 1996;  167(4) 1025-1028
  • 16 Czerny C, Hofmann S, Neuhold A et al.. Lesions of the acetabular labrum: accuracy of MR imaging and MR arthrography in detection and staging.  Radiology. 1996;  200(1) 225-230
  • 17 Hase T, Ueo T. Acetabular labral tear: arthroscopic diagnosis and treatment.  Arthroscopy. 1999;  15(2) 138-141
  • 18 Pfirrmann C W, Mengiardi B, Dora C, Kalberer F, Zanetti M, Hodler J. Cam and pincer femoroacetabular impingement: characteristic MR arthrographic findings in 50 patients.  Radiology. 2006;  240(3) 778-785
  • 19 Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock K A. Femoroacetabular impingement: a cause for osteoarthritis of the hip.  Clin Orthop Relat Res. 2003;  417(417) 112-120
  • 20 Boutin R D, Newman J S. MR imaging of sports-related hip disorders.  Magn Reson Imaging Clin N Am. 2003;  11(2) 255-281
  • 21 Byrd J W, Jones K S. Traumatic rupture of the ligamentum teres as a source of hip pain.  Arthroscopy. 2004;  20(4) 385-391
  • 22 Arendt E A, Griffiths H J. The use of MR imaging in the assessment and clinical management of stress reactions of bone in high-performance athletes.  Clin Sports Med. 1997;  16(2) 291-306
  • 23 Fredericson M, Bergman A G, Hoffman K L, Dillingham M S. Tibial stress reaction in runners. Correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system.  Am J Sports Med. 1995;  23(4) 472-481
  • 24 Vande Berg B C, Malghem J J, Lecouvet F E, Jamart J, Maldague B E. Idiopathic bone marrow edema lesions of the femoral head: predictive value of MR imaging findings.  Radiology. 1999;  212(2) 527-535
  • 25 Kaplan P A, Helms C A, Dussault R, Anderson M W, Major N M. Musculoskeletal MRI. Philadelphia, PA: WB Saunders; 2001: 337-339
  • 26 Combs J A. Hip and pelvis avulsion fractures in adolescents.  Phys Sportsmed. 1994;  22 41-49
  • 27 Stevens M A, El-Khoury G Y, Kathol M H, Brandser E A, Chow S. Imaging features of avulsion injuries.  Radiographics. 1999;  19(3) 655-672
  • 28 Nelson E N, Kassarjian A, Palmer W E. MR imaging of sports-related groin pain.  Magn Reson Imaging Clin N Am. 2005;  13(4) 727-742
  • 29 el-Khoury G Y, Daniel W W, Kathol M H. Acute and chronic avulsive injuries.  Radiol Clin North Am. 1997;  35(3) 747-766
  • 30 Gamble J G, Kao J. Avulsion fracture of the lesser trochanter in a preadolescent athlete.  J Pediatr Orthop B. 1993;  2 188-190
  • 31 De Paulis F, Cacchio A, Michelini O, Damiani A, Saggini R. Sports injuries in the pelvis and hip: diagnostic imaging.  Eur J Radiol. 1998;  27(Suppl 1) S49-S59
  • 32 Metzmaker J N, Pappas A M. Avulsion fractures of the pelvis.  Am J Sports Med. 1985;  13(5) 349-358
  • 33 Palmer W E, Kuong S J, Elmadbouh H M. MR imaging of myotendinous strain.  AJR Am J Roentgenol. 1999;  173(3) 703-709
  • 34 Wunderbaldinger P, Bremer C, Schellenberger E, Cejna M, Turetschek K, Kainberger F. Imaging features of iliopsoas bursitis.  Eur Radiol. 2002;  12(2) 409-415
  • 35 De Maeseneer M, Gosselin R, De Ridder F, Shahabpour M, Vanderdood K. MR imaging changes in the trochanteric area of asymptomatic individuals: a potential for misdiagnosis of pain in the trochanteric region.  Eur J Radiol. 2009;  72(3) 480-482
  • 36 Choi Y S, Lee S M, Song B Y, Paik S H, Yoon Y K. Dynamic sonography of external snapping hip syndrome.  J Ultrasound Med. 2002;  21(7) 753-758
  • 37 Kaplan P A, Helms C A, Dussault R, Anderson M W, Major N M. Musculoskeletal MRI. Philadelphia, PA: WB Saunders; 2001: 66-67

Jeremiah C HealyF.R.C.P. F.R.C.R. F.F.S.E.M. 

Radiology Department, Chelsea and Westminster Hospital

London SW10 9NH, UK

Email: j.healy@ic.ac.uk

    >