Osseous Reasons of Groin Pain by Young Athletics
Chronic pain in the hip, groin or thigh can be caused by a wide spectrum of diseases posing extended diagnostic problems. This abstract focuses on the most common osseous reasons for groin pain. Stress fracture The etiology of stress fractures is primary based on overstraining of the involved structures and fatigue of the muscles. Mainly endurance athletes are affected by stress fractures, which usually occur in the hip- or pelvic-region. In the ventral pelvic-region fractures of the pubis bone are the most common. After diagnosis based on magnetic resonance imaging, mostly a conservative treatment is sufficient (walking with rakes for minimum 4 weeks). Ventral pelvic instability The hip bones are connected among themselves anteriorly at the pubic symphysis, and posteriorly to the sacrum at the sacroiliac joints to form the pelvic ring. Sports like soccer, horse riding, ice hockey, or athletic sports can lead to ventral pelvic instability through increased chronic shear crafts on the symphysis. For diagnosis pelvic overview and one leg standing X-ray is used. A conservative therapy is primary aspired to improve the stability of the skeletal muscles in combination with wearing a pelvic restraint belt. If conservative treatment fails, symphysis can be fixed operatively with a board. Acetabular labrum lesion. The acetabular labrum increases the contact area in the hip joint, functions as a shock absorber, and improves the stability of the hip joint. Acute pelvic luxations, congential dysplasions of the hip, or coxarthrosis can be combined with labrum lesions. In recent literature sports activity and femoroacetabular impingement are associated with acetabular labrum lesions. For imaging the magnetic resonance tomography is preferred. The therapy depends on the location and severity of the lesion. A broad spectrum for treatment depending on the location and severity of the lesion has been described in literature. It ranges from partial weight bearing over arthroscopic procedures to open pelvic revision operations. Femoroacetabular impingment We differ between cam impingement and pincer impingement. Cam impingement is caused by aspherically femoral head or a lacking offset between the head and collum. Pincer impingement is characterized by an extra bone that reaches out over the normal rim of the acetabulum. Therefore the anterior labrum can be crushed under the prominent rim of the acetabulum. For medical treatment Glucsosaminosulfate, Hyaluronic Acid, or Interleukin-1-Receptor Antagonists can be prescribed, in conservative therapy improvement of the coordination and balance, as well as active and passive therapies can be applied. In case of surgery arthroscopy and open hip revision are the treatments of choice. Beside the above mentioned causes, Epiphyseolysis capitis femoris and Morbus Perthes should also be taken into consideration.
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