Athletic pubalgia: clinical synonym but not correctly used as imaging term
Definitions
Clinical syndrome of midline groin pain related to athletic activity
Pubic bodies serve as attachments for rectus abdominis, adductors (especially adductor longus), inguinal ligament, multiple pubic ligaments
Rectus abdominis fibers continue over pubis and into adductor longus as rectus-adductor aponeurosis
Midline pubic plate is anterior midline tissue with contributions from aponeuroses, anterior pubic ligament, periosteum of pubic bones
Aponeurosis (lateral portion) or midline pubic plate can be detached from pubis, strained, frankly torn, or any combination
Detachments often occur with strain; frank tears less common but still prevalent
Sports hernia debated as actual entity: some state deficiency in posterior inguinal wall causes pain, benefits from surgical repair; concept strongly doubted as typical primary culprit by others
Not true inguinal or femoral hernia
Terminology continues to evolve
IMAGING
General Features
Imaging Recommendations
Radiographic Findings
Fluoroscopic Findings
CT Findings
MR Findings
Ultrasonographic Findings
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Reporting Tips
Selected References
Boric I et al: Imaging of articular and extra-articular sports injuries of the hip. Semin Musculoskelet Radiol. 23(3):e17-36, 2019
Lee SC et al: Imaging of groin pain: magnetic resonance and ultrasound imaging features. Sports Health. 9(5):428-35, 2017
Larbi A et al: MRI in patients with chronic pubalgia: is precise useful information provided to the surgeon? A case-control study. Orthop Traumatol Surg Res. 102(6):747-54, 2016
Coker DJ et al: The role of magnetic resonance imaging in athletic pubalgia and core muscle injury. Top Magn Reson Imaging. 24(4):183-91, 2015
Hopp SJ et al: Osteitis pubis and adductor tendinopathy in athletes: a novel arthroscopic pubic symphysis curettage and adductor reattachment. Arch Orthop Trauma Surg. 133(7):1003-9, 2013
Khan W et al: Magnetic resonance imaging of athletic pubalgia and the sports hernia: current understanding and practice. Magn Reson Imaging Clin N Am. 21(1):97-110, 2013
Murphy G et al: "Superior cleft sign" as a marker of rectus abdominus/adductor longus tear in patients with suspected sportsman's hernia. Skeletal Radiol. 42(6):819-25, 2013
Palisch A et al: Imaging of athletic pubalgia and core muscle injuries: clinical and therapeutic correlations. Clin Sports Med. 32(3):427-47, 2013
Weber MA et al: Groin pain in athletes. Rofo. ePub, 2013
Balconi G: US in pubalgia. J Ultrasound. 14(3):157-66, 2011
Meyers WC et al: Experience with "sports hernia" spanning two decades. Ann Surg. 248(4):656-65, 2008
Omar IM et al: Athletic pubalgia and "sports hernia": optimal MR imaging technique and findings. Radiographics. 28(5):1415-38, 2008
Shortt CP et al: Anatomy, pathology, and MRI findings in the sports hernia. Semin Musculoskelet Radiol. 12(1):54-61, 2008
Zajick DC et al: Spectrum of MRI findings in clinical athletic pubalgia. Semin Musculoskelet Radiol. 12(1):3-12, 2008
Zoga AC et al: Athletic pubalgia and the "sports hernia": MR imaging findings. Radiology. 247(3):797-807, 2008
Cunningham PM et al: Patterns of bone and soft-tissue injury at the symphysis pubis in soccer players: observations at MRI. AJR Am J Roentgenol. 188(3):W291-6, 2007
Robinson P et al: Cadaveric and MRI study of the musculotendinous contributions to the capsule of the symphysis pubis. AJR Am J Roentgenol. 188(5):W440-5, 2007
Brennan D et al: Secondary cleft sign as a marker of injury in athletes with groin pain: MR image appearance and interpretation. Radiology. 235(1):162-7, 2005
Robinson P et al: Adductor-related groin pain in athletes: correlation of MR imaging with clinical findings. Skeletal Radiol. 33(8):451-7, 2004
Meyers WC et al: Management of severe lower abdominal or inguinal pain in high-performance athletes. PAIN (Performing Athletes with Abdominal or Inguinal Neuromuscular Pain Study Group). Am J Sports Med. 28(1):2-8, 2000
Athletic pubalgia: clinical synonym but not correctly used as imaging term
Definitions
Clinical syndrome of midline groin pain related to athletic activity
Pubic bodies serve as attachments for rectus abdominis, adductors (especially adductor longus), inguinal ligament, multiple pubic ligaments
Rectus abdominis fibers continue over pubis and into adductor longus as rectus-adductor aponeurosis
Midline pubic plate is anterior midline tissue with contributions from aponeuroses, anterior pubic ligament, periosteum of pubic bones
Aponeurosis (lateral portion) or midline pubic plate can be detached from pubis, strained, frankly torn, or any combination
Detachments often occur with strain; frank tears less common but still prevalent
Sports hernia debated as actual entity: some state deficiency in posterior inguinal wall causes pain, benefits from surgical repair; concept strongly doubted as typical primary culprit by others
Not true inguinal or femoral hernia
Terminology continues to evolve
IMAGING
General Features
Imaging Recommendations
Radiographic Findings
Fluoroscopic Findings
CT Findings
MR Findings
Ultrasonographic Findings
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Reporting Tips
Selected References
Boric I et al: Imaging of articular and extra-articular sports injuries of the hip. Semin Musculoskelet Radiol. 23(3):e17-36, 2019
Lee SC et al: Imaging of groin pain: magnetic resonance and ultrasound imaging features. Sports Health. 9(5):428-35, 2017
Larbi A et al: MRI in patients with chronic pubalgia: is precise useful information provided to the surgeon? A case-control study. Orthop Traumatol Surg Res. 102(6):747-54, 2016
Coker DJ et al: The role of magnetic resonance imaging in athletic pubalgia and core muscle injury. Top Magn Reson Imaging. 24(4):183-91, 2015
Hopp SJ et al: Osteitis pubis and adductor tendinopathy in athletes: a novel arthroscopic pubic symphysis curettage and adductor reattachment. Arch Orthop Trauma Surg. 133(7):1003-9, 2013
Khan W et al: Magnetic resonance imaging of athletic pubalgia and the sports hernia: current understanding and practice. Magn Reson Imaging Clin N Am. 21(1):97-110, 2013
Murphy G et al: "Superior cleft sign" as a marker of rectus abdominus/adductor longus tear in patients with suspected sportsman's hernia. Skeletal Radiol. 42(6):819-25, 2013
Palisch A et al: Imaging of athletic pubalgia and core muscle injuries: clinical and therapeutic correlations. Clin Sports Med. 32(3):427-47, 2013
Weber MA et al: Groin pain in athletes. Rofo. ePub, 2013
Balconi G: US in pubalgia. J Ultrasound. 14(3):157-66, 2011
Meyers WC et al: Experience with "sports hernia" spanning two decades. Ann Surg. 248(4):656-65, 2008
Omar IM et al: Athletic pubalgia and "sports hernia": optimal MR imaging technique and findings. Radiographics. 28(5):1415-38, 2008
Shortt CP et al: Anatomy, pathology, and MRI findings in the sports hernia. Semin Musculoskelet Radiol. 12(1):54-61, 2008
Zajick DC et al: Spectrum of MRI findings in clinical athletic pubalgia. Semin Musculoskelet Radiol. 12(1):3-12, 2008
Zoga AC et al: Athletic pubalgia and the "sports hernia": MR imaging findings. Radiology. 247(3):797-807, 2008
Cunningham PM et al: Patterns of bone and soft-tissue injury at the symphysis pubis in soccer players: observations at MRI. AJR Am J Roentgenol. 188(3):W291-6, 2007
Robinson P et al: Cadaveric and MRI study of the musculotendinous contributions to the capsule of the symphysis pubis. AJR Am J Roentgenol. 188(5):W440-5, 2007
Brennan D et al: Secondary cleft sign as a marker of injury in athletes with groin pain: MR image appearance and interpretation. Radiology. 235(1):162-7, 2005
Robinson P et al: Adductor-related groin pain in athletes: correlation of MR imaging with clinical findings. Skeletal Radiol. 33(8):451-7, 2004
Meyers WC et al: Management of severe lower abdominal or inguinal pain in high-performance athletes. PAIN (Performing Athletes with Abdominal or Inguinal Neuromuscular Pain Study Group). Am J Sports Med. 28(1):2-8, 2000
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