Groin Pain

Groin pain can be disabling to the high-performance and recreational athlete. It is often associated with sports requiring kicking and rapid change in directions, such as soccer, rugby, hockey, and American football players [16]. Injury data from the National Hockey League reveals groin injury occurs at a rate of 13 to 20 injuries per 100 players per year [71].

The differential for chronic groin pain is broad and includes both musculoskeletal and genitourinary etiologies. Musculoskeletally, the top differential includes intra-articular hip pathology (labral tears), true palpable hernia, nonpalpable posterior abdominal wall abnormalities (sports hernia and groin

Hip Adductor Pathology
Fig. 17. Axial fluid-sensitive images showing abnormal edema and some cortical destruction (arrow) in a recreational 26-year-old hockey player. The injury did not improve after 8 weeks with rest and subsequently was proven to be lymphoma.

disruption), rectus abdominus injury, osteitis pubis, and adductor-related muscle and tendon injury.

The term athletic pubalgia has been used to describe inguinal pain with exertion without exam findings of a hernia, which can occur in recreational and elite athletes [72]. This clinical diagnosis is composed of two basic posterior abdominal wall abnormalities, sports hernias and groin disruptions. These terms are often used interchangeably but a sports hernia defect usually is the result of occult direct or indirect hernias, whereas groin disruption involves injuries to the adjacent transversalis fascia, oblique muscles and aponeurosis, conjoined tendon, and rectus abdominus insertion [73]. Many imaging studies have been used over the years to diagnose this entity, including herniorrhaphy (in-traperitoneal injection of contrast to see if it enters the inguinal canal) although this technique is no longer widely performed [74]. Ultrasound has been found to be useful for posterior abdominal wall deformities [75].

We prefer MRI evaluation as a means of evaluating patients with athletic pu-balgia not because of its poor ability to detect posterior abdominal wall injuries but rather to identify other causes of pain such as bone stress reactions and adductor-related injury. Occasionally abdominal wall defects such as asymmetric muscle wall attenuation, fat herniation into the inguinal canal, and parasym-physeal bone marrow edema may be seen with cases of sports hernia [61]

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