MR findings in patients with athletic pubalgia: our experience

Transcription

1 MR findings in patients with athletic pubalgia: our experience Poster No.: C-0727 Congress: ECR 2015 Type: Scientific Exhibit Authors: P. Schvartzman, A. Fernandez Viña, F. Olmos Cantarero, J Buteler ; Buenos Aires/, Tucumán/ Keywords: Musculoskeletal system, Trauma, MR, Ultrasound, Arthrography, Athletic injuries DOI: /ecr2015/C-0727 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 17

2 Aims and objectives To recognize the frequency and radiological findings of the pathologic conditions associated with athletic pubalgia. Page 2 of 17

3 Methods and materials 42 patients with a mean age of 34 years were studied retrospectively. They had insidious onset of groin pain, which in most cases was radiating to the thigh adductor muscle. They were all recreational athletes. They were evaluated by a 3T and 1.5 T MRI units. The protocol of study was combined between fat-suppresed fluid-sensitive sequences and non-fat suppressed T1 weighted in the three standard orthogonal planes. In addition, an axial oblique sequences along the axis of the arcuate line was performed to improve diagnostic accuracy. Page 3 of 17

4 Results In 72% of cases we reached the diagnosis of athletic pubalgia. Most of the lessions including primary injury of rectus abdominis-adductor aponeurosis. They were often associated with bone marrow edema and the so called secondary cleft sign. It was also observed in some cases an association with lesions involving the adductor brevis and pectineus. Other pathologies that were found to a lesser extent were osteitis pubis, stress fracture, labral tear, apofisitis and inguinal hernia. Fig. 1: Coronal oblique MR acquisitions along the axis of the arcuate line perform in order to improve diagnostic accuracy. Page 4 of 17

5 References: Diagnóstico por Imágenes, Centro Médico Deragopyan - Buenos Aires/ Fig. 2: Axial oblique MR acquisitions along the axis of the arcuate line perform in order to improve diagnostic accuracy. Page 5 of 17

6 Fig. 3: Adductor longus and pectineus tendinosis. Axial oblique STIR image obtained in a 35-year-old male hockey player shows mild thickening of the left adductor longus and pectineus tendons with intrasubstance signal intensity changes (arrow). Bone marrow edema that extends throughout both pubic bodies was also seen. Page 6 of 17

7 Fig. 4: Adductor longus, brevis and pectineus tendinosis. Coronal STIR image shows thickening and intrasubstance signal intensity changes involving the left adductor longus (arrow), brevis and pectineus tendons. Bone marrow edema that extends throughout both pubic bodies was also seen. Page 7 of 17

8 Fig. 5: Tear of the left rectus abdominis-adductor longus aponeurosis in a 24-year old football player with left-sided athletic pubalgia. Sagital STIR image demonstrates the typical appearance of a tear (arrow) with signal intensity similar to fluid within the aponeurosis approximately 1 cm below the pubic symphysis. Page 8 of 17

9 Fig. 6: Adductor tendon avulsion. Axial STIR image in a 36-year-old male football player with acute onset of left inguinal pain shows frank avulsion of the left adductor longus and brevis tendons and associated muscle strain (arrow). Fig. 7: Marrow edema associated with aponeurosis injury in a 36-year-old hockey female player. Axial STIR image demonstrates a subtle disruption of the right rectus Page 9 of 17

10 abdominis-adductor longus aponeurosis and associated marrow edema in the pubic body (arrow). Fig. 8: Adductor tendon avulsion. Coronal oblique STIR image in a 25-year-old female hockey player shows avulsion of the right adductor longus with associated muscle strain of adductor brevis and pectineus (arrow). References: Imágenes del Norte-Tucumán-Argentina Page 10 of 17

11 Fig. 9: Tear of the left rectus abdominis-adductor longus aponeurosis. Sagital T2weighted fat-suppressed image shows a broad tear that involves the adductor longus 1 cm below the pubic body (arrow). References: Imágenes del Norte-Tucumán-Argentina Page 11 of 17

12 Fig. 10: Injury to the rectus abdominis-adductor longus aponeurosis. Coronal oblique T2-weighted fat-suppressed image in a 31-year-old male basketball player shows the secondary cleft sign as an area of hyperintense signal (arrow) along the anteriorinferior margin of the right pubic body that reflect a microtear. Ipsilateral bone marrow edema is also seen. Page 12 of 17

13 Fig. 11: Athletic pubalgia in a 44-year-old long-distance male runner. Axial STIR image shows a broad tear of the rectus abdominis-adductor longus right aponeurosis, below the pubic crest (arrow) with ipsilateral bone marrow edema. Page 13 of 17

14 Fig. 12: Osteitis pubis in a 22-year old male soccer player. Coronal oblique STIR image demonstrates articular surface irregularity associated with marrow edema that extends throughout both pubic bodies. Page 14 of 17

15 Conclusion The value of MRI for the clinical work-up of athletic pubalgia increases with the radiologist's familiarity with and recognition of injury patterns in the anatomic structures surrounding the pubic symphysis. Unenhanced MR imaging with a dedicated protocol allows the diagnosis of subtle pathologic changes including primary injury of the rectus abdominis-adductor aponeurosis length. Thus, provide us an appropriate plan of treatment that enable sports reinstatement in the shortest time possible. Page 15 of 17

16 Personal information Centro Médico Deragopyan Amenábar 1331 CP 1426 Buenos Aires. Argentina Page 16 of 17

17 References Omar IM, Zoga AC. Athletic Pubalgia and "Sports Hernia": Optimal MR Imaging Technique and Findings. RadioGraphics 2008; 28: Ekstrand J, Gillquist J. The avoidability of soccer injuries. Int J Sports Med 1983; 4(2): Ekstrand J, Hilding J. The incidence and differential diagnosis of acute groin injuries in male soccer players. Scand J Med Sci Sports 1999; 9: Emery CA, Meeuwisse WH. Risk factors for groin injuries in hockey. Med Sci Sports Exerc 2001;33: Harris NH, Murray RO. Lesions of the symphysis in athletes. Br Med J 1974; 4(5938): Morelli V, Weaver V. Groin injuries and groin pain in athletes: part 1. Prim Care 2005; 32: Lynch SA, Renström PA. Groin injuries in sport:treatment strategies. Sports Med 1999; 28: Williams A, ed. Thigh. In: Stranding S, ed. Gray's anatomy: the anatomical basis of clinical practice. 39th ed. Edinburgh, Scotland: Elsevier Churchill Livingstone, 2005; Gamble JG, Simmons SC, Freedman M. The symphysis pubis: anatomic and pathologic considerations. Clin Orthop Relat Res 1986;203: Brennan D, O'Connell MJ, Ryan M, et al. Secondary cleft sign as a marker of injury in athletes with groin pain: MR image appearance and interpretation. Radiology 2005;235: Page 17 of 17