Imaging of Hip and Groin Injuries in Athletes

Kimberlee Horton Overdeck; William Ewing Palmer

doi:10.1055/s-2004-823014

Seminars in Musculoskeletal Radiology, Table of Contents

Semin Musculoskelet Radiol 2004; 8(1): 41-55
DOI: 10.1055/s-2004-823014

Imaging of Hip and Groin Injuries in Athletes

Kimberlee Horton Overdeck¹ , William Ewing Palmer¹

¹Department of Bone and Joint Radiology, Massachusetts General Hospital, Boston, MA

Abstract

Proper function of the hip joint is imperative for athletes who participate in sporting activities that rely on utilization of the lower extremity; these primarily include kicking, running, and jumping activities. Sports-related injuries of the hip and groin are not frequent sources of disability in athletes; however, they may present a significant diagnostic dilemma, both from a clinical and radiological standpoint. Delay in diagnosis and treatment may result in undesired complications, such as premature degenerative disease, as well as time lost from athletic activities. Magnetic resonance (MR) imaging of the hip, particularly following the intra-articular administration of gadolinium, has proven to be extremely valuable in the diagnosis of radiographically occult osseous abnormalities as well as soft-tissue injuries, such as pubalgia, musculotendinous abnormalities, and bursitis. This article will review several pathological conditions of the hip and groin in both recreational and professional athletes, with an emphasis on MR imaging as the modality of choice in the diagnosis of these injuries.

KEYWORDS

Hip - athlete - injuries

Full Text

References

REFERENCES

1 Boyd K T, Peirce N S, Batt M E. Common hip injuries in sport. Sports Med. 1997; 24 273-288
2 Anderson K, Strickland S M, Warren R. Hip and groin injuries in athletes. Am J Sports Med. 2001; 29 521-533
3 Manaster B J. From the RSNA refresher courses. Adult chronic hip pain: radiographic evaluation. Radiographics. 2000; 20 S3-S25
4 Hayes C W, Balkissoon A A. Magnetic resonance imaging of the musculoskeletal system. II. The hip. Clin Orthop. 1996; 171 279-309
5 Palmer W E. MR arthrography of the hip. Semin Musculoskelet Radiol. 1998; 2 349-361
6 Grainger A J, Elliot J M, Campbell R S et al.. Direct MR arthrography: a review of current use. Clin Radiol. 2000; 55 163-176
7 Steinbach L S, Palmer W E, Schweitzer M E. MR arthrography. Radiographics. 2002; 22 1223-1246
8 Bencardino J T, Palmer W E. Imaging of hip disorders in athletes. Radiol Clin North Am. 2002; 40 267-287
9 Mason J B. Acetabular labral tears in the athlete. Clin Sports Med. 2001; 20 779-790
10 Fitzgerald Jr R H. Acetabular labrum tears: diagnosis and treatment. Clin Orthop. 1995; 211 60-68
11 Petersilge C A, Haque M A, Petersilge W J et al.. Acetabular labral tears: evaluation with MR arthrography. Radiology. 1996; 200 231-235
12 Czerny C, Hofmann S, Neuhold A et al.. Lesions of the acetabular labrum: accuracy of MR imaging and MR arthrography in detection and staging. Radiology. 1996; 200 225-230
13 Lage L A, Patel J V, Villar R N. The acetablular labral tear: an arthroscopic classification. Arthroscopy. 1996; 12 269-272
14 Santori N, Villar R N. Acetabular labral tears: result of arthroscopic partial limbectomy. Arthroscopy. 2000; 16 11-15
15 Dipaola J D, Nelson D W, Colville M R. Characterizing osteochondral lesions by magnetic resonance imaging. Arthroscopy. 1991; 7 101-104
16 Bohndorf K. Imaging of acute injuries of the articular surfaces (chondral, osteochondral, and subchondral fractures). Skeletal Radiol. 1999; 28 545-560
17 Kramer J, Stiglbauer R, Engel A, Drayer L, Imnof H. MR contrast arthrography (MRA) in osteochondrosis dissecans. J Comput Assist Tomogr. 1992; 16 254-260
18 Albers S L, Spritzer C E, Garrett Jr W E, Meyers W C. MR findings in athletes with pubalgia. Skeletal Radiol. 2001; 30 270-277
19 O'Connell M J, Powell T, McCaffrey N M, O'Connell D, Eustace S J. Symphyseal cleft injection in the diagnosis and treatment of osteitis pubis in athletes. AJR Am J Roentgenol. 2002; 179 955-959
20 Gilmore J. Groin pain in the soccer athlete: fact, fiction, and treatment. Clin Sports Med. 1998; 17 787-793
21 Fon L J, Spence A J. Sportsman's hernia. Br J Surg. 2000; 87 545-552
22 Malycha P, Lovell G. Inguinal surgery in athletes with chronic groin pain: the “sportsman's” hernia. Aust N Z J Surg. 1992; 62 123-125
23 Smedberg S G, Broome A EA, Elmer O, Gullmo A. Herniography in the diagnosis of obscure groin pain. Acta Chir Scand. 1985; 151 663-667
24 DeSmet A A, Best T M. MR imaging of the distribution and location of acute hamstring injuries in athletes. AJR Am J Roentgenol. 2000; 174 393-399
25 Kurosawa H, Nakasita K, Nakasita H, Sasaki S, Takeda S. Complete avulsion of the hamstring tendons from the ischial tuberosity: a report of two cases sustained in judo. Br J Sports Med. 1996; 30 72-74
26 Takayanagi H, Watanabe H, Shinozaki T et al.. Overgrowth of the ischial tuberosity complicating femoral bone and muscle atrophy: implications for a delayed complication of malunited apophyseal avulsion fracture. Am J Orthop. 1998; 27 308-312
27 Stevens M A, El Khoury G Y, Kathol M H, Brandser E A, Chow S. Imaging features of avulsion injuries. Radiographics. 1999; 19 655-672
28 Afra R, Boardman D L, Kabo J M, Eckhardt J J. Avulsion fracture of the lesser trochanter as a result of a preliminary malignant tumor of bone: a report of four cases. J Bone Joint Surg Am. 1999; 81 1299-1304
29 Phillips C D, Pope Jr T L, Jones J E, Keats T E, MacMillan III R H. Nontraumatic avulsion of the lesser trochanter: a pathognomonic sign of metastatic disease?. Skeletal Radiol. 1988; 17 106-110
30 Akcali O, Kossay C, Gunal I, Alici E. Bilateral trochanteric fractures of the femur in a patient with chronic renal failure. Int Orthop. 2000; 24 179-180
31 Gibbon W W, Hession P R. Diseases of the pubis and pubic symphysis: MR imaging appearances. AJR Am J Roentgenol. 1997; 169 849-853
32 Palmer W E, Kuong S J, Elmadbouh H M. MR imaging of myotendinous strain. AJR Am J Roentgenol. 1999; 173 703-709
33 May D A, Disler D G, Jones E A, Balkissoon A A, Manaster B J. Abnormal signal intensity in skeletal muscle at MR imaging: patterns, pearls, and pitfalls. Radiographics. 2000; 20 S295-S315
34 Temple H T, Kuklo T R, Sweet D E, Gibbons M H, Murphey M D. Rectus femoris muscle tear appearing as a pseudotumor. Am J Sports Med. 1998; 26 544-548
35 Steinbach L S, Fleckenstein J L, Mink J H. Magnetic resonance imaging of muscle injuries. Orthopedics. 1994; 17 991-999
36 Fleckenstein J L, Weatherall P T, Parkey R W, Payne J A, Peshock R M. Sports-related muscle injuries: evaluation with MR imaging. Radiology. 1989; 172 793-798
37 DeSmet A A. Magnetic resonance findings in skeletal muscle tears. Skeletal Radiol. 1993; 22 479-484
38 Friedenstein A Y. Osteogenic stem cells in the bone marrow. In: Heersche JNM, Kanis JA Bone and Mineral Research. Amsterdam; Elsevier Science Publishers 1990: 243-272
39 Lipscomb A B, Thomas E D, Johnston R K. Treatment of myositis ossificans traumatica in athletes. Am J Sports Med. 1976; 4 111-120
40 Shin A Y, Gillingham B L. Fatigue fractures of the femoral neck in athletes. J Am Acad Orthop Surg. 1997; 5 293-302
41 Otte M T, Helms C A, Fritz R C. MR imaging of supra-acetabular insufficiency fractures. Skeletal Radiol. 1997; 26 279-283
42 Lee J K, Yao L. Stress fractures: MR imaging. Radiology. 1998; 169 217-220
43 Kneeland J B. MR imaging of sports injuries of the hip. Magn Reson Imaging Clin N Am. 1999; 7 105-115
44 Shbeeb M I, Matteson E L. Trochanteric bursitis (greater trochanteric pain syndrome). Mayo Clin Proc. 1996; 71 565-569
45 Jones D L, Erhard R E. Diagnosis of trochanteric bursitis versus femoral neck stress fracture. Phys Ther. 1997; 77 58-67
46 Haller C C, Coleman P A, Estes N C, Grisolia A. Traumatic trochanteric bursitis. Kans Med. 1989; 90 17-18, 22
47 Swartout R, Compere E L. Ischiogluteal bursitis; the pain in the arse. JAMA. 1974; 227 551-552
48 Kim S M, Shin M J, Kim K S et al.. Imaging features of ischial bursitis with an emphasis on ultrasonography. Skeletal Radiol. 2002; 31 631-636
49 Johnston C A, Wiley J P, Lindsay D M, Wiseman D A. Iliopsoas bursitis and tendonitis; a review. Sports Med. 1998; 25 271-283
50 Vacarro J P, Sauser D D, Beals R K. Iliopsoas bursa imaging: efficacy in depicting abnormal iliopsoas tendon motion in patients with internal snapping hip syndrome. Radiology. 1995; 197 853-856
51 Pelsser V, Cardinal E, Hobden R, Aubin B, Lafortune M. Extraarticular snapping hip: sonographic findings. AJR Am J Roentgenol. 2001; 176 67-73

Kimberlee Horton OverdeckM.D.

Assistant in Radiology, Massachusetts General Hospital, Department of Bone and Joint Radiology

15 Parkman Street, WACC 515

Boston, MA 02114