Sports Injuries and Groin Pain
Groin pain is a common yet often complex presenting symptom in patients with sports injuries. Five percent of all patients referred to sports medicine clinics have groin injuries. Such injuries account, however, for a greater percentage of time lost from
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Introduction Groin pain is a common yet often complex presenting symptom in patients with sports injuries. Five percent of all patients referred to sports medicine clinics have groin injuries. l Such injuries account, however, for a greater percentage of time lost from sport. Injuries to the groin are unilateral or bilateral; they may be acute but are more often subacute or chronic. In many patients, groin pain presents a challenging management problem.2 Because of the various anatomical structures involved, patients with sports injuries of the groin may be referred to orthopedic, urological, or general surgeons, as well as to sports medicine specialists. The assessment of such patients includes taking a careful history, meticulous examination of the abdomen, spine, hips, groin, scrotum, and lower limbs, and appropriate investigations. The most common causes of groin pain in sport are reviewed in Table 97.1.
Direct Trauma Direct trauma may result from falls, punches, stick injuries, or kicks to the groin, resulting in injuries to the external genitalia, muscles, vessels, nerves, bones, and joints of the pelvis. Diagnosis is based on history and examination, and in some patients x-rays, ultrasonography, magnetic resonance imaging (MRI), or even arteriography is indicated.
may also be of value. 4 Treatment involves a prolonged period of rest. Local steroid injection may be of benefit, provided that infection can be excluded. Some patients may require symphysis pubis fusion. In the past, a number of patients underwent unnecessary pelvic fusion due to misdiagnosis. They were in fact suffering from groin disruption, a condition only recently recognized. 5
Muscle Injuries
Adductor Adductor injuries occur in sportsmen as a result of eversion, abduction, and external rotation. Onset may be acute but is more often insidious due to repeated minor traumas. Examination reveals local tenderness at the adductor origins, extending along the muscles themselves. Pain is exacerbated by passive abduction and resisted adduction. Ultrasonography and MRI scanning may be useful in delineating the lesion.
Iliopsoas Iliopsoas strains occur when the hip is flexed actively against resistance, as sometimes occurs with repeated and rapid sit-ups. Tenderness is often difficult to localize as the iliopsoas origin is deep. Hip flexion against resistance is often painful.
Rectus Femoris Osteitis Pubis Osteitis pubis used to be the most common diagnosis in soccer players with groin pain. 3 Today osteitis pubis is better referred to as symphysis pubis instability. It is a distinct entity, but its occurrence is not as frequent as was once thought. It is a low grade inflammation with associated increased movement at the symphysis pubis. The patient usually complains of pain in the midline over the symphysis pubis and has a typical radiological appearance. Similar radiological findings are, however, present in many soccer players who have been active for many years. In osteitis pubis, scintigraphy using technetium-99m shows an increased uptake at
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