Groin Injuries and Groin Pain in Athletes: Part 2

https://doi.org/10.1016/j.pop.2004.11.012Get rights and content

Section snippets

Disorders of the os pubis

Osteitis pubis, or inflammation of the symphysis pubis, is seen commonly in runners [1], hockey players [2], and soccer players. In this condition, shearing forces across the pubic symphysis may result in symphysis inflammation or even joint disruption [3]. Repetitive adductor pull on the symphysis has also been proposed as one of the etiologic mechanisms [2]. Cutting and twisting forces may transmit even greater forces to the pubic symphysis in athletes lacking ideal ranges of hip flexibility

Osteomylitis of the pubic symphysis

Another condition that must be kept in the differential diagnosis of osteitis pubis is osteomyelitis, or bacterial infection of the pubic symphysis or adjacent bone. This condition is usually seen following surgical procedures in the area, but has also been seen after childbirth [18], and has been reported to occur spontaneously in athletes [19], [20], [21]. A recent review of 100 cases reported that 24% of cases occurred after female incontinence surgery, 19% occurred spontaneously in

Stress fractures

The two most common stress fractures of the groin region are femoral neck stress fractures and pubic ramus fractures. They are caused by repetitive overuse and overload, and are usually seen in distance runners or military recruits. Additional risk factors include relative osteoporosis in young female athletes who have nutritional or hormonal imbalances, muscle fatigue (which may reduce shock-absorbing abilities), changes in foot gear or training surface, and sudden increases in intensity or

Disorders of the hip

When evaluating groin pain in the athlete, the physician must remember that hip pathology can refer pain to the groin region. Acetabular labral tears, articular cartilage defects of the femoral head or acetabulum, loose bodies, capsular laxity, and injuries to the ligamentum teres all may present as groin pain. Other less common presenting conditions include osteonecrosis of the femoral head, slipped capital femoral epiphysis, gout, pseudogout, synovial chondromatosis, and infection [30].

First page preview

First page preview
Click to open first page preview

References (67)

  • J.G. Williams

    Limitation of hip joint movement as a factor in traumatic osteitis pubis

    Br J Sports Med

    (1978)
  • O. Ekberg et al.

    Longstanding groin pain in athletes. A multidisciplinary approach

    Sports Med

    (1988)
  • N. Westlin

    Groin pain in athletes from Southern Sweden

    Sports Medicine and Arthroscopy Review

    (1997)
  • P.A. Fricker

    Management of groin pain in athletes

    Br J Sports Med

    (1997)
  • N.H. Harris et al.

    Lesions of the symphysis in athletes

    BMJ

    (1974)
  • J. Karlsson et al.

    The use of radiography, magnetic resonance, and ultrasound in the diagnosis of hip, pelvis, and groin injuries

    Sports Medicine and Arthroscopy Review

    (1997)
  • A. Barile et al.

    Groin pain in athletes: magnetic resonance imaging evaluation

    Radiol Med (Torino)

    (2000)
  • S.A. Lynch et al.

    Groin injuries in sport: treatment strategies

    Sports Med

    (1999)
  • M.A. Holt et al.

    Treatment of osteitis pubis in athletes. Results of corticosteroid injections

    Am J Sports Med

    (1995)
  • W.P. Maksymowych et al.

    Treatment of refractory symphysitis pubis with intravenous pamidronate

    J Rheumatol

    (2001)
  • M.B. Coventry et al.

    Osteitis pubis: observations based on a study of 45 patients

    JAMA

    (1961)
  • J.N. Grace et al.

    Wedge resection of the symphysis pubis for the treatment of osteitis pubis

    J Bone Joint Surg Am

    (1989)
  • R.S. Moore et al.

    Late posterior instability of the pelvis after resection of the symphysis pubis for the treatment of osteitis pubis. A report of two cases

    J Bone Joint Surg Am

    (1998)
  • P.R. Williams et al.

    Osteitis pubis and instability of the pubic symphysis. When nonoperative measures fail

    Am J Sports Med

    (2000)
  • C. Eskridge et al.

    Osteomyelitis pubis occurring after spontaneous vaginal delivery: a case presentation

    J Perinatol

    (1997)
  • J.A. Combs

    Bacterial osteitis pubis in a weight lifter without invasive trauma

    Med Sci Sports Exerc

    (1998)
  • S.A. Hedstrom et al.

    Acute hematogenous pelvic osteomyelitis in athletes

    Am J Sports Med

    (1982)
  • S. Pauli et al.

    Osteomyelitis pubis versus osteitis pubis: a case presentation and review of the literature

    Br J Sports Med

    (2002)
  • J.J. Ross et al.

    Septic arthritis of the pubic symphysis: review of 100 cases

    Medicine (Baltimore)

    (2003)
  • H.P. Roos

    Hip pain in sport

    Sports Medicine and Arthroscopy Review

    (1997)
  • C. Rolf

    Pelvis and groin stress fractures: a cause of groin pain in athletes

    Sports Medicine and Arthroscopy Review

    (1997)
  • A.Y. Shin et al.

    The superiority of magnetic resonance imaging in differentiating the cause of hip pain in endurance athletes

    Am J Sports Med

    (1996)
  • J.T. Bencardino et al.

    Magnetic resonance imaging of the hip: sports-related injuries

    Top Magn Reson Imaging

    (2003)
  • Cited by (37)

    • MRI in patients with chronic pubalgia: Is precise useful information provided to the surgeon? A case-control study

      2016, Orthopaedics and Traumatology: Surgery and Research
      Citation Excerpt :

      AP is a relatively common occurrence and has been attributed to one of three broad etiological categories: AL lesion, osteitis pubis, parietal lesion [16]. As treatment plans have diverged in recent years on the basis of the specific structures involved, it is now necessary for the clinician to accurately localize the injury and determine its severity and extent [17,18]. Many studies assessed and described good accuracy for MR imaging in AP, in contrast for the majority of series, physical examination findings remained the reference standard with high prevalence of MRI abnormalities in asymptomatic patients [12,19].

    • Imaging features of pubalgia

      2011, Journal de Radiologie
    • Atlas of Pain Management Injection Techniques, FIFTH EDITION

      2022, Atlas of Pain Management Injection Techniques, FIFTH EDITION
    • An Innovative Approach for a Hip Disorders Rehabilitation

      2022, Lecture Notes in Networks and Systems
    • Hip tendinopathies

      2017, Muscle and Tendon Injuries: Evaluation and Management
    View all citing articles on Scopus
    View full text