Adductor tendinopathy in a hockey player with persistent groin pain: a case report

Groin pain may stem from a variety of different causes. Adductor tendinopathy is a common but infrequently recognised cause of chronic groin pain especially in athletes. This case report describes a case of clinically suspected adductor tendinopathy in an amateur athlete confirmed by MRI (Magnetic Resonance Imaging). Relevant literature on musculotendinous injuries of the groin along with differential diagnosis for groin pain is discussed. There are several differential diagnoses for athletes that present with groin pain. Therefore, it is important to accurately diagnose the origin of groin pain as the plan of management is dependent of the specificity of the diagnosis. The diagnosis of adductor tendinopathy is made with a history of chronic groin pain along with pain/weakness during isometric adduction of the hip muscles. It is confirmed by MR imaging.     

Osteitis pubis in elite athletes: Diagnostic and therapeutic approach

Osteitis pubis (OP) is a debilitating overuse syndrome characterizing by pelvic pain and local tenderness over the pubic symphysis commonly encountered in athletes often involved in kicking, twisting and cutting activities in sports such as soccer and rugby and to a lesser degree distance running. It is a common source of groin pain in elite athletes attributable to pubis sympysis instability as the result of microtrauma caused by repetitive muscle strains on pubic bones. Diagnosis is based mainly on detailed sports history and a meticulous clinical examination, although occasionally is difficult to distinguish this nosological entity from other pathologies affecting the involved area which may occur concomitantly in the same patient. Radiologic examinations such as plain radiographs, magnetic resonance imaging and 3 phase bone isotope scanning may be helpful to differentiate from other clinical entities with similar clinical presentation. Most cases respond well to conservative treatment which includes several physical modalities and especially a progressive rehabilitation programmed individualized to each one of patients diagnosed with OP. Local injection therapies have been also been proposed as a non-operative therapeutic option for the efficient management of these patients. In refractory cases, surgical therapeutic strategies are warranted. These include several open or minimally invasive surgical interventions such as arthroscopic or open symphysis curettage, wedge or total resection of pubic sympysis, polypropylene mesh placement and pubic fusion. In this review a critical analysis of OP in elite athletes is performed with special focus on current concepts of diagnosis and management of this source of athletic groin pain.     

Sportsman's hernia

BACKGROUND: Sportsman's hernia is a debilitating condition which presents as chronic groin pain. A tear occurs at the external oblique which may result in an occult hernia. The definition, investigation and treatment of this condition remain unclear. METHODS: A systematic Medline search was performed and all literature pertaining to chronic groin pain, groin injury, sportsman's hernia and sportsman's groin from 1962 to 1999 was retrieved for analysis. RESULTS: The costs of computed tomography and magnetic resonance imaging are such that their routine use for assessment of patients with groin pain cannot be justified. They may, however, be employed in difficult cases to help define the anatomical extent of a groin injury. Plain radiography, ultrasonography and scintigraphy should be the usual first-line investigations to supplement clinical assessment. Herniography may help in situations of obscure chronic groin and pelvic pain. There is no consensus view supporting any particular surgical procedure for sportsman's hernia. A number of reports have been published describing different repairs of the posterior inguinal wall deficiency. Appropriate repair of the posterior wall results in therapeutic benefit in selected cases. CONCLUSION: The diagnosis of sportsman's hernia is difficult. The condition must be distinguished from the more common osteitis pubis and musculotendinous injuries. Early surgical intervention is usually, although not always, successful when conservative management has failed.     

Imaging of hip injuries in dancers

Dancers are quite prone to injuries in the hip region. Imaging plays a key role in evaluation of the pain resulting from such injuries, as proximity of structures and cross-innervation can result in a clinical dilemma regarding the specific injury, and thus origin of the pain generator. Advanced imaging techniques, including MRI, ultrasound, and multidetector CT, are becoming increasingly important in the workup of injuries in athletes, yet radiographs remain an essential component. This article presents a variety of injuries in the hip and groin region that may be seen in dancers and discusses the utility of basic and advanced imaging modalities.     

Chronic Groin Pain in Athletes: Sportsman’s Hernia with Bilateral Femoral Hernia

The differential diagnosis of chronic groin pain in athletes is a long list and its evaluation is a challenging task. Sports hernia, one of the common cause of these groin pains, had been managed both with open & endoscopic repairs in the past. We report a case of sports hernia in young footballer who presented with bilateral groin pain for 5 years. Endoscopic hernioplasty was done (by totally extra-peritoneal technique) which identified bilateral occult femoral hernia and were repaired simultaneously. Post op outcome was good with excellent results.     

Neurovascular trauma in athletes

Injuries to neurovascular structures are not the most common injuries seen in athletes and for this reason may often be overlooked. Additionally, diagnosis and management may be more difficult because of inexperience with these injuries. The majority of acute sports-related neurovascular injuries are associated with contact sports such as rugby, wrestling, ice hockey, and especially football. These injuries most commonly occur about the shoulder girdle and brachial plexus, with "burners" syndrome being the most common. Less common injuries include thoracic outlet syndrome, effort-induced thrombosis, axillary artery occlusion, and peripheral nerve injuries, as well as compression syndromes involving the axillary, suprascapular, and long thoracic nerves.     

Editorial Commentary: More Evidence That Some Sports Are Harder on Hips Than Others

Femoroacetabular impingement (FAI) is generally agreed to be one of the main causes of hip osteoarthritis later in life. There is a strong association between certain sports and hip arthroscopy with labral repair and osteochondroplasty for FAI. Some sports, such as ice hockey, soccer, and basketball, place substantial mechanical demands on the hip, thus causing more hip injuries in athletes who participate in them. Sports medicine physicians caring for athletes playing “hip-intense” sports should have a low index of suspicion for FAI, even if the initial injury is described only as a groin strain. In addition, evidence is accumulating that sports-related pressure on the femoral physis during closure causes cam deformity and resultant FAI. Although this may be unpopular with coaches and parents, orthopaedists as a group should begin to research and advocate preventive measures including likely activity limitations for adolescent athletes playing these sports.     

Neuropathy of the obturator nerve as a source of pain in soccer players]

Chronic inguinal and lower abdominal pain in high-performance athletes is common and often disabling problem. Diagnose and treatment is often difficult due to many anatomic structures in the inguinal and groin region that have the potential to cause pain. We report 52 cases of a chronic groin pain in soccer players due to fascial entrapment of the obturator nerve. All patients presented clinical symptoms and signs of post exercise groin, lower abdominal or medial tight pain and adductor muscles weakness and paresthesia in cutaneous distribution of medial thigh. Except clinical signs in the diagnosis of obturator neuropathy we used diagnostic local anaesthetic block and electromyography. In 52 patients the cause of chronic groin pain was obturator neuropathy and they were treated operatively. Surgical neurolysis provided the definitive cure of pain in 41 players.     

Sports hernia: diagnosis and therapeutic approach

Groin pain is a common entity in athletes involved in soccer, ice hockey, Australian Rules football, skiing, running, and hurdling. An increasingly recognized cause of groin pain in these athletes is a sports hernia, an occult hernia caused by weakness or tear of the posterior inguinal wall, without a clinically recognizable hernia, that leads to a condition of chronic groin pain. The patient typically presents with an insidious onset of activity-related, unilateral, deep groin pain that abates with rest. Although the physical examination reveals no detectable inguinal hernia, a tender, dilated superficial inguinal ring and tenderness of the posterior wall of the inguinal canal are found. The role of imaging studies in this condition is unclear; most imaging studies will be normal. Unlike most other types of groin pain, sports hernias rarely improve with nonsurgical measures; thus, open or laparoscopic herniorrhaphy should be considered.     

Elbow problems associated with sports injuries in children

Elbow problems associated with sports injuries may result from overuse, micro- or macrotraumas. Overuse injuries are frequent and are often closely related to mechanical characteristics of sports. Sports-related elbow injuries mainly occur in sports involving throwing such as baseball and javelin throwing, which require forced valgus and extension of the elbow, predisposing it to overuse injuries. Overuse injuries in child athletes are generally defined as Little League elbow, the most common of which are medial epicondyle apophysitis, osteochondritis dissecans of the capitellum, radial head deformation, flexion contractures, and injuries to the olecranon. Most of these injuries can be healed without or with minimal sequelae by early diagnosis and proper treatment. Therefore, mechanisms of, and risk factors for, elbow problems encountered in pediatric athletes should be well-understood in order to avoid the risks for a permanent deformity in the child's anatomy.     

Imaging of adductor-related groin pain

Groin pain is a common condition in athletes and results from various causes. Osteitis pubis, adductor dysfunction, inguinal hernia, or a combination of all three entities, generally explains the onset of symptoms. Adductor longus tendinopathy is the main cause of adductor-related groin pain. It leads to a significant reduction of sports participation and can require surgical management. Diagnosis is based on ultrasonography and magnetic resonance imaging. Asymptomatic findings (tendinosis, calcifications, cortical erosions) are common in athletes and care should be taken when assessing groin pain. The most specific sign of tendinopathy is an intratendinous tear of the adductor longus.     

Long-term follow-up of laparoscopic preperitoneal hernia repair in professional athletes

BACKGROUND: "Athletic pubalgia" is a term often used to describe the insidious onset of groin pain in professional athletes. This pain may be caused by a range of musculoskeletal conditions. The diagnosis of occult or "sports" hernia must be considered in athletes who do not respond to conservative treatment modalities directed at these entities. PATIENTS AND METHODS: Fifteen professional athletes were treated for sports hernia by a single surgeon between February 1994 and June 2000. Laparoscopic hernia repairs were performed using an extraperitoneal approach. Athletes presented with symptoms lasting several months to several years. Long-term follow-up was obtained by phone to assess overall patient satisfaction, efficacy of surgery, and effect on athletic performance. RESULTS: Nearly all (87%) of the athletes were able to return to full, unrestricted athletic activity in 4 weeks or less. Overall long-term satisfaction was high. Long-term follow-up revealed no adverse sequelae or recurrence of symptoms at a median of 46 months. CONCLUSION: Laparoscopic preperitoneal hernia repair should be considered as a treatment modality in athletes presenting with chronic groin pain.     

Differentiating giant cell tumor of bone from patellofemoral syndrome: a case study

Balancing the assessment of musculoskeletal dysfunctions with a high level of suspicion for non-mechanical origins can be a challenge for the clinician examining a sports injury. Without timely diagnosis, non-mechanical complaints could result in surgery or loss of limb. This case describes the discovery of a Giant Cell Tumor of Bone (GCTB) following the re-evaluation of an athlete who had undergone five years of conservative management for patellofemoral pain syndrome (PFPS). Knee injuries account for 32.6% of sports injuries with PFPS being the most common and most likely diagnosis for anterior knee pain. GCTB is a benign aggressive bone tumor with a predilection for the juxta-articular region of the knee, comprising up to 23% of all benign bone tumors, and commonly occurs in the second to fourth decades. This case report illustrates the difficulty in accurately diagnosing healthy athletes, reviews common differentials for knee complaints and explores helpful diagnostic procedures.     

Surgical treatment of chronic groin pain in athletes

Purpose

Conservative treatment of chronic groin pain is prolonged and recurrence is quite common. Coexistence of sports hernia and adductor tendinitis/tendinosis in a single patient is noted in the literature. In our study we evaluated our operative treatment that should enable pain elimination and fast return to sports activities.

Methods

We performed a prospective study over a six-year period. Ninety-nine (99) patients, all male, with chronic groin pain, resistant to conservative treatment, underwent a surgical procedure.

Results

Seventy athletes with sports hernia returned to sports in an average 4.23 weeks (range three–16). Adductor tendinosis symptoms were present in 24 patients (2 %) with sports hernia. Twenty-four patients that had an additional adductor tenotomy performed returned to sports in an average 11.6 weeks (range ten–15). Five patients with isolated adductor tendinosis (7 %) returned to sports in an average 13.4 weeks (range 12–16). All athletes except two (2.8 %) treated for sports hernia were satisfied with the results of treatment and could continue their previous level of activity.

Conclusion

Any surgical procedure used for treating chronic groin pain should address the common causes of pain in this region. Adductor tendinosis can be present in up to 24.2 % of cases with sports hernia or may be isolated in 7 % of cases with chronic groin pain and must be treated by tenotomy. Resection of the genital branch of genitofemoral nerve and ilioinguinal nerve neurolysis should also be performed in patients with sports hernia.     

Treatment of shoulder pain in thesenior athlete

As our population ages, seniors participating in sports or fitness programs are being seen more frequently in orthopedic practices for the complaint of shoulder pain. While evaluation and treatment of the senior athlete is similar to evaluation and treatment of the younger athlete, the senior cohort presents some specific challenges. Diagnosis is more difficult: underlying disease processes including cervical spondylosis, cardiac and neoplastic diseases are more common. Physical examination is important, because magnetic resonance scans may present many abnormalities not all of which are symptomatic. We reserve magnetic resonance scanning for patients in whom the diagnosis is in question, or for those who fail conservative measures. Surgical treatment is complicated by the quality of tissue to repair. Proper rehabilitation, for both nonsurgical and operative treatment is essential and should be physician directed. Finally, many senior athletes have unrealistic expectations of treatment underscoring the need, for good patient-physician communication.     

Idiopathic scoliosis and spondylolysis in the female athlete. Tips for treatment

Idiopathic scoliosis and spondylolysis can be common back problems in female athletes. Diagnosis and treatment can be difficult. With the notable trend toward increasing participation of women and girls in organized sports, it is necessary to know which sports carry additional risks for participants to have these two conditions develop and to determine treatment modalities. In general, idiopathic scoliosis is more prevalent in females and even may be higher in the athletes. Treatment options may include observation, the use of a brace, and surgery. In determining treatment, the type of sport and caliber of athlete must be considered in conjunction with the severity of the curve. Spondylolysis or a stress fracture of the posterior vertebral elements can be a common cause of back pain in an athlete. In many sports that are dominated by females (gymnastics, dancing, figure skating), the athletes carry a high risk of having spondylolysis or a stress fracture. Knowing the risk factors permits precise diagnosis and appropriate treatment. Treatment options include the use of a brace and surgery. In the current study, an extensive review of the literature in conjunction with the extensive experience of a well-established sports medicine clinic at the authors' institution is presented.     

Rehabilitation of articular lesions in the athlete's knee

Articular cartilage lesions of the knee joint are common in patients of varying ages. Some articular cartilage lesions are focal lesions located on one aspect of the tibiofemoral or patellofemoral joint. Other lesions can be extremely large or involve multiple compartments of the knee joint and these are often referred to as osteoarthritis. There are numerous potential causes for the development of articular cartilage lesions: joint injury (trauma), biomechanics, genetics, activities, and biochemistry. Numerous factors also contribute to symptomatic episodes resulting from lesions to the articular cartilage: activities (sports and work), joint alignment, joint laxity, muscular weakness, genetics, dietary intake, and body mass index. Athletes appear to be more susceptible to developing articular cartilage lesions than other individuals. This is especially true with specific sports and subsequent to specific types of knee injuries. Injuries to the anterior cruciate ligament and/or menisci may increase the risk of developing an articular cartilage lesion. The treatment for an athletic patient with articular cartilage lesions is often difficult and met with limited success. In this article we will discuss several types of knee articular cartilage injuries such as focal lesions, advanced full-thickness lesions, and bone bruises. We will also discuss the risk factors for developing full-thickness articular cartilage lesions and osteoarthritis, and describe the clinical evaluation and nonoperative treatment strategies for these types of lesions in athletes.     

Acute and overuse injuries in elite paracycling - an epidemiological study

Although paracycling is a growing discipline in high level competitive sports as well as in posttraumatic rehabilitation, epidemiological data of?resulting injuries is still missing. Therefore, 19 athletes of the German national paracycling team were asked about their injuries during the 2008 season using a standardized questionnaire. Overall, 18 (94.7?%) of 19 athletes reported overuse injuries; most commonly localized at the back (83.3?%), neck/shoulder (77.8?%), knee (50?%), groin/buttock (50?%) and hands/wrists (38.9?%). Altogether, 18 accidents were registered, corresponding to an injury rate of 0,95 acute injuries per athlete per year (0,07?/?1000?km). The most common acute injuries were abrasions (69.2?%) and contusions (61.5?%), whereas fractures were stated only twice (11.8?%). The anatomical distribution of overuse injuries in disabled cyclists confirms the results of studies in able-bodied cycling, although the incidences in low-back pain and neck/shoulder pain is clearly higher in disabled cycling, as well as the rate of traumatic injuries.     

Return to play criteria for the athlete with cervical spine injuries resulting in stinger and transient quadriplegia/paresis.

BACKGROUND CONTEXT: Fortunately, catastrophic cervical spinal cord injuries are relatively uncommon during athletic participation. Stinger and transient quadriplegia/paresis are more frequent injuries that have a wide spectrum of clinical severity and disabilities. Although the diagnosis of these injuries may not be clinically difficult, the treatment and decision about when or if the athlete may return to play after such an injury is often unclear. PURPOSE: This article reviews the current literature to help determine reasonable guidelines for return-to-play criteria after cervical spine injuries in the athlete. METHODS: The contemporary English literature and experience-based guidelines for return to play after cervical spine injuries in the athlete were reviewed. RESULTS: Despite the frequency of cervical-related injuries among athletes participating in contact and collision sports, no consensus exists within the medical field as to a standard guideline approach for return to preinjury activity level. CONCLUSION: The issue of return to play for an athlete after a cervical spine injury is controversial. Tremendous extrinsic pressures may be exerted on the physician from noninvolved and involved parties. The decision to return an athlete to a particular sport should be based on the mechanism of injury, objective anatomical injury (as demonstrated by clinical examination and radiographic evaluation) and an athlete's recovery response.     

Prevalence and etiological factors of sport-related groin injuries in top-level soccer compared to non-contact sports

Purpose  

Groin injuries and chronic pain are relatively common in soccer and other contact sports. Our aim was to define the gender-related frequency of both acute and chronic groin injuries in soccer compared to non-contact endurance sports.