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Background: It is unknown if football players with femoroacetabular impingement (FAI) syndrome report worse burden than those with other causes of hip/groin pain, and to what extent this is mediated by cartilage defects and labral tears., Hypothesis: Football players with FAI syndrome would report worse burden than other symptomatic players, with the effect partially mediated by cartilage defects and/or labral tears., Study Design: Cross-sectional study., Level of Evidence: Level 4., Methods: Football (soccer and Australian football) players (n = 165; 35 women) with hip/groin pain (≥6 months and positive flexion-adduction-internal rotation test) were recruited. Participants completed 2 patient-reported outcome measures (PROMs; the International Hip Outcome Tool-33 [iHOT-33] and Copenhagen Hip and Groin Outcome Score [HAGOS]) and underwent hip radiographs and magnetic resonance imaging (MRI). FAI syndrome was determined to be present when cam and/or pincer morphology were present. Cartilage defects and labral tears were graded as present or absent using MRI. Linear regression models investigated relationships between FAI syndrome (dichotomous independent variable) and PROM scores (dependent variables). Mediation analyses investigated the effect of cartilage defects and labral tears on these relationships., Results: FAI syndrome was not related to PROM scores (unadjusted b values ranged from -4.693 ( P = 0.23) to 0.337 ( P = 0.93)) and cartilage defects and/or labral tears did not mediate its effect ( P = 0.22-0.97)., Conclusion: Football players with FAI syndrome did not report worse burden than those with other causes of hip/groin pain. Cartilage defects and/or labral tears did not explain the effect of FAI syndrome on reported burden., Clinical Relevance: FAI syndrome, cartilage defects, and labral tears were prevalent but unrelated to reported burden in symptomatic football players.

Purpose: To investigate the prevalence of magnetic resonance imaging (MRI) findings and define prognostic factors of the return-to-play time in young athletes with groin pain., Methods: A total of 1091 consecutive athletes were retrospectively screened; 651 athletes, aged 16-40 years, with pain in the groin regions were assessed using MRI. Of these athletes, 356 were included for analysing the time to return-to-play. Univariate and multiple linear regression analyses were used to determine the associations between the time to return-to-play (primary outcome variable) and the following variables: age, sex, body mass index, type of sports, Hip Sports Activity Scale, clear trauma history, and 12 MRI findings., Results: Four MRI findings, including cleft sign, pubic bone marrow oedema of both the superior and inferior ramus, and central disc protrusion of the pubic symphysis, appeared together in more than 44% of the cases. The median time to return-to-play was 24.7 weeks for athletes with a cleft sign on MRI, which was significantly longer than the 11.9 weeks for athletes without the sign. The median time to return-to-play was 20.8 weeks for athletes with BMI > 24, which was significantly longer than the 13.6 weeks for athletes with BMI ≦ 24. In multiple linear regression analysis of 356 athletes, in whom hip-related groin pain was excluded, and who were followed-up until the return-to-play, the body mass index and cleft sign were the independent factors associated with a delayed return-to-play. In contrast, iliopsoas muscle strain and other muscle injuries were associated with a shorter return-to-play., Conclusions: Multiple MRI findings were present in almost half of all cases. Body mass index and the cleft sign were independently associated with a delayed return-to-play time in young athletes suffering from groin pain., Level of Evidence: III.

Follow-up imaging confirmed a clinical suspicion.

Context: Evaluation of groin pain in athletes may be challenging as pain is typically poorly localized and the pubic symphyseal region comprises closely approximated tendons and muscles. As such, magnetic resonance imaging (MRI) and ultrasound (US) may help determine the etiology of groin pain., Evidence Acquisition: A PubMed search was performed using the following search terms: ultrasound, magnetic resonance imaging, sports hernia, athletic pubalgia, and groin pain. Date restrictions were not placed on the literature search., Study Design: Clinical review., Level of Evidence: Level 4., Results: MRI is sensitive in diagnosing pathology in groin pain. Not only can MRI be used to image rectus abdominis/adductor longus aponeurosis and pubic bone pathology, but it can also evaluate other pathology within the hip and pelvis. MRI is especially helpful when groin pain is poorly localized. Real-time capability makes ultrasound useful in evaluating the pubic symphyseal region, as it can be used for evaluation and treatment., Conclusion: MRI and US are valuable in diagnosing pathology in athletes with groin pain, with the added utility of treatment using US-guided intervention. Strength-of Recommendation Taxonomy: C.

This article outlines adductor-related groin pain, pubic-related groin pain, inguinal-related groin pain, and iliopsoas-related groin pain, with a description of the corresponding functional anatomy and imaging findings. The imaging has been described mainly in terms of MR imaging findings as this is the principal imaging modality used to investigate groin pain, although plain radiographs and ultrasound can be very useful adjuncts in specific circumstances, especially if an alternative pathology needs to be excluded., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Athletes are particularly predisposed to injuries in the groin and pelvic region. Men in particular are predisposed to injuries like hernias in the inguinal region. The increased demands and training load on today's athletes combined with individual factors may create the environment for these injuries. Five areas categorize the pain present from different pathological entities in this region: adductor-related, iliopsoas-related, inguinal-related, pubic-related, and hip-related groin pain. It has been extremely difficult in the past to accurately diagnose what has been previously labeled sports hernia, sportsman's groin, or inguinal disruption. Therefore, this article describes the methods and procedures used for diagnostic ultrasound (US) and differentiation between these entities from one practice based on the most current research in musculoskeletal US.

De Garengeot hernia is a rare clinical entity defined as the presence of a vermiform appendix within a femoral hernia sac. A 50-year-old woman presented to the emergency department with a painful lump over her right groin region. A bedside ultrasound was performed and soft tissue lesion was suspected. CT was performed and revealed a swollen tubular structure with fat stranding within the mass. De Garengeot hernia with acute appendicitis was diagnosed preoperatively, and an emergency appendectomy and hernioplasty were performed. Although it is usually an incidental finding during hernioplasty, De Garengeot hernia should be considered in the differential diagnosis of patients with an incarcerated femoral hernia. Mesh repair can be performed depending on the clinical situation. We report a rare case of incarcerated femoral hernia with acute appendicitis that required early surgical management to avoid associated complications., (2015 BMJ Publishing Group Ltd.)

Objectives: Symptomatic groin hernias in women may be difficult to assess clinically and commonly mimic pathologic musculoskeletal and gynecologic conditions. The objective of our study was to investigate the accuracy of sonography in women with groin pain and normal physical examination findings., Methods: A consecutive group of 87 women (median age, 44.6 years; range, 19-82 years) with groin pain and normal physical examination findings were included in the study. All patients had a standardized sonographic examination of the groin performed by an experienced radiologist or a sonographer. If a groin hernia was identified, it was classified as indirect, direct, or femoral. Normal examination findings and alternate pathologic groin conditions were also recorded. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for the sonographic findings and compared to the findings for patients sent for surgery., Results: Of the 87 women with groin pain, 37 groin hernias were diagnosed in 35 patients. Surgery was performed in 26 patients (27 groins). Sonography correctly depicted and classified groin hernias in 18 of the 21 groins that had surgical confirmation. Six women without groin hernias also had surgical exploration of the affected side. The sensitivity, specificity, positive predictive value, and negative predictive value for the patients with surgical confirmation were 95%, 75%, 95%, and 75%, respectively. Groin pain in 26 patients was attributed to other causes. The remainder of the patients had normal examination findings or were lost to follow-up., Conclusions: Groin hernias in women can be occult and confound the clinical diagnosis. In a woman with groin pain and normal or indeterminate physical examination findings, we have found that sonography can accurately depict and classify groin hernias and other pathologic processes.

Hip and groin pain are a common complaint among athletes of all ages, and may result from an acute injury or from chronic, repetitive trauma. Hip injuries can be intraarticular, extraarticular, or both. Labral abnormalities may occur in asymptomatic patients as well as in those with incapacitating symptoms and signs. Athletic hip injury leading to disabling intraarticular hip pain most commonly involves labral tear. The extraarticular causes are usually the result of overuse activity, leading to inflammation, tendonitis, or bursitis. In clinical practice, the term athletic pubalgia is used to describe exertional pubic or groin pain., (Copyright © 2011 Elsevier Inc. All rights reserved.)

This article reviews the clinical, anatomical, and biomechanical basis of pubalgia and relates it to the potential imaging findings and subsequent management. Although the magnetic resonance imaging features typically seen in symptomatic athletes are emphasized, this condition remains a complex clinical problem, and treatment addressing the functional rehabilitation of the entire region is highlighted., (© Thieme Medical Publishers.)

Chronic groin pain is a common entity in the sporting population and causes considerable morbidity. The differential diagnosis is wide, and this article presents a review of the common causes with particular reference to anatomy, ultrasound and magnetic resonance imaging (MRI) findings.

Background: Cryotechnology is a modality of renewed interest in pain management. It is safe and effective when used to treat neuropathies of sensory and mixed nerves. Cryoablation, in general, is devoid of the risk of neuroma formation and can provide several weeks to months of adequate pain relief. Traditionally, cryoablation was applied blindly to the target area. The use of ultrasound guidance may improve the efficacy and reduce morbidity. We report a case of a successful cryoablation of the femoral component of the genitofemoral nerve using ultrasound guidance in a patient with chronic inguinal pain. A 47 year-old male (ASA Classification II for obesity, HLD, and OSA, 125kg, 69 in) presented to the Walter Reed Pain Clinic with the complaint of 4/10 VAS left sided groin pain of 3 month duration. The patient was diagnosed with a neuropathy of the femoral component of the left genitofemoral nerve. He received a diagnostic block with local anesthetic and reported immediate pain relief that lasted one week. The patient was counseled on the risks and benefits of cryoablation. The skin was anesthetized with 1% lidocaine and a 14 gauge angiocatheter needle was introduced using an in-plane technique to the target area. A Westco Cryoablation machine (San Diego, California) with a 14 gauge Lloyd Neurostat cryoprobe was then passed via the angiocatheter. The area was treated for two 3-minute intervals while the cryo probe was visualized under ultrasound. Ultrasound is increasingly utilized for both acute and chronic pain procedures. Ultrasound offered several advantages in this case. It allowed a smaller gauge introducer and cryoablation probe to be used since there was better visualization of the target area. Ultrasound helped identify important vascular structures, allowing safe introduction of the introducer and cryoablation probe. The patient remains pain free at 2-month follow-up.

The value of diagnostic ultrasound for detecting occult inguinal hernia in The aim of this study was to demonstrate the accuracy of ultrasound in diagnosing occult hernia in patients with recurrent inguinal pain and a negative clinical examination. Over a period of three years, a total of 51 patients were referred for ultrasound examination with clinically suspected occult inguinal hernia. Patients with positive US scans were offered surgery, while those with negative US findings were offered further imaging or other diagnostic tests. The ultrasound examination of the inguinal region was conducted using a 5-10 MHz linear probe. The scan was performed with the patient in the supine and erect positions, in a relaxed state, as well as during coughing and during a Valsalva manoeuvre. Overall, ultrasound diagnosed 20 inguinal hernias and all 20 patients with positive scans underwent surgery. Surgery confirmed the ultrasound diagnosis in 19 patients, only 1/20 having no hernia at operation (100% ultrasound sensitivity and 96.9% specificity). Patients undergoing surgery showed complete symptom resolution at a three-month follow-up. This study confirms that ultrasound is capable of accurately diagnosing groin hernia and this may justify its use in patients with chronic groin pain due to a suspected occult hernia.

Objective: To describe the sonographic appearances of the normal tensor fascia lata (TFL) origin and to describe the sonographic changes that were present in the TFL of a group of athletes presenting with anterior groin pain., Design: The sonographic appearances of the TFLs of 40 healthy asymptomatic volunteers were evaluated. The TFLs of approximately 200 patients aged between 16 and 55 years presenting with anterior groin pain were evaluated in the course of routine sonographic assessment of the hip. Twelve abnormal TFLs were identified in 12 patients aged between 16 and 53 years. A retrospective review of the appearance of the normal and abnormal tendon with respect to its overall size and echotexture was made., Results: The normal TFL has a thin ribbon-like appearance with a clearly defined fibrillar pattern and a mean anteroposterior (AP) size of 2.1 mm (range 1.5-3.1 mm). In the patient cohort the TFL typically appeared enlarged and contained a cone-shaped area of hypoechogenicity based on the iliac crest within the deep fibers of the origin. The TFL origin was enlarged up to 2 1/2 times its normal size. The mean AP size of the abnormal TFL was 4.7 mm (range 3.1-7.0 mm)., Conclusion: Tendinopathy of the TFL is a cause of anterior groin pain. Sonography can be used to depict changes in the TFL, confirming the diagnosis and assessing the severity of the tendinopathy.

Groin pain is common among athletes. In its acute form the pain is usually overuse-related and is treated conservatively, whereas in chronic groin pain the clinical picture is often more complex. Successful treatment is dependent on correct diagnosis, as there are multiple differential diagnosis. Surgery has been associated with good results in chronic cases, the most common interventions being adductor tenotomy, abdominal wall repair, and neurotomy of the ilioinguinal and/or iliohypogastric nerve. Which surgical approach should be adopted is dependent on the results of investigation to identify the causative factor.

The inguinofemoral region is a crossroads of numerous vascular, nervous and muscular structures. As even the most astute clinician can have difficulty in correctly diagnosing the cause of complaints or a mass in the groin and thigh region, radiological investigation is frequently warranted. For the radiologist involved, knowledge of the anatomy and specific pathology of the groin is essential. This paper deals with the imaging characteristics of the various diseases in the inguinofemoral triangle. Furthermore, this article provides an overview of the role of the various imaging modalities in the evaluation of disease in the groin and upper thigh. A sound working knowledge of groin anatomy and pathology is mandatory. The various imaging modalities used should be considered complementary.

Herniographies were performed on 106 outpatients with obscure groin pain. A total of 39 hernias were found in 38 patients (36%) and the 46 patients either operated on (40 patients) or who had undergone laparoscopy (six patients), included one false positive and two false negative ones. All three cases were inpatients who had earlier undergone surgery for inguinal hernia 27% of the patients with a normal clinical finding (19/70), 67% of those with previous inguinal herniotomy (8/12) and 50% of those with symptoms suggestive of hernia (12/24) had diagnostic findings on herniography. Thirteen out of the 48 women (27%) and 25 of the 58 men (43%) had positive finding at herniography. The valve of herniography was that 56 patients were spared subsequent surgical exploration because of normal herniographic finding. Our results indicate that herniography is a useful tool for the examination of patients with unexplained groin pain.

To evaluate its clinical benefit in adults, herniography was used in 73 patients with clinically unexplained groin pain. Hernias were demonstrated on the side with symptoms in 26 patients (36%). Relief of groin pain was registered in 16 of 17 patients who subsequently underwent operation. We consider herniography to be of value in the examination of adult patients with clinically unclear groin pain.