Adductor-related groin pain in competitive athletes - Role of adductor enthesis, magnetic resonance imaging, and entheseal pubic cleft injections
ABSTRACT Adductor dysfunction is a condition that can cause groin pain in competitive athletes, but the source of the pain has not been established and no specific interventions have been evaluated. We previously defined a magnetic resonance imaging protocol to visualize adductor enthesopathy. The aim of this study was to elucidate, in the context of adductor-related groin pain in the competitive athlete, the role of the adductor enthesis (origin), the relevance of adductor enthesopathy diagnosed with magnetic resonance imaging, and the efficacy of entheseal pubic cleft injections of local anesthetic and steroids.
We reviewed the findings in a consecutive series of twenty-four competitive athletes who had presented to our sports medicine clinic with groin pain secondary to adductor longus dysfunction. Magnetic resonance imaging was performed to assess the adductor longus origin for the presence or absence of enthesopathy. Seven patients (Group 1) had no evidence of enthesopathy on magnetic resonance imaging, and seventeen patients (Group 2) had enthesopathy confirmed on magnetic resonance imaging. All patients were treated with a single pubic cleft injection of local anesthetic and steroid into the adductor enthesis. At one year after this treatment, the patients were assessed for recurrence of symptoms.
On clinical reassessment five minutes after the injection, all twenty-four athletes reported resolution of the groin pain. At one year, none of the seven patients in Group 1 had experienced a recurrence. Sixteen of the seventeen patients in Group 2 had a recurrence of the symptoms (p < 0.001) at a mean of five weeks (range, one to sixteen weeks) after the injection.
A single entheseal pubic cleft injection can be expected to afford at least one year of relief of adductor-related groin pain in a competitive athlete with normal findings on a magnetic resonance imaging scan; however, it should be employed only as a diagnostic test or short-term treatment for a competitive athlete with evidence of enthesopathy on magnetic resonance imaging.
SourceAvailable from: Cristiano Frota de Souza Laurino[Show abstract] [Hide abstract]
ABSTRACT: Esta publicação aborda temas do universo da traumatologia do esporte, que levantam discussões amplas sobre a fisiopatologia, os fatores de risco, as formas ideais de tratamento e as implicações no praticante de esportes. O primeiro tema abrange a dor no universo do esporte, um fenômeno fisiológico fundamental para a manutenção da integridade dos tecidos e, sobretudo, da vida. Apresentamos conceitos, a fisiopatologia dos tipos de dor e as abordagens de tratamento dentre os grupos de patologias mais frequentes no esporte. Especificamente para o ortopedista, a dor é um dos sintomas mais frequentes na prática diária e para o profissional que trabalha com o esporte, seja ele recreacional, amador ou profissional, a dor é um dos parâmetros limitadores do rendimento, gerando como consequências a perda de concentração, a insegurança e até a incapacitação. O segundo tema aborda as luxações patelofemorais; embora muitos estudos apontem para uma grande incidência de luxações da articulação patelofemoral nas populações ativas, poucos deles descrevem as reais taxas de incidência ou examinam os fatores de risco desta lesão. A literatura atual apresenta controvérsias quanto aos fatores de risco e as formas de tratamento nas luxações agudas da patela. Na população de atletas, permanecem as discussões sobre a melhor forma de tratamento e suas relações com os fatores de risco. Embora os estudos englobando pequenas séries de casos apontem para o reparo cirúrgico precoce, grandes estudos prospectivos e randomizados têm mostrado não haver vantagem significante no tratamento cirúrgico comparado ao conservador. O último tema aborda algumas das causas de dores localizadas na região inguinal de caráter crônico nos praticantes de esportes que realizam movimentos rápidos e repetitivos de aceleração e desaceleração, além de mudanças bruscas de direção e rotação. As lesões na região inguinal representam uma parcela menor de todas as lesões no esporte, mas muitas destas lesões permanecem não diagnosticadas ainda nos dias de hoje. Dentre as lesões, descrevemos as “hérnias do esportista”. Muitas são as nomenclaturas utilizadas atualmente para descrever as dores inguinais crônicas, o que desperta dúvidas quanto à fisiopatologia das lesões envolvidas no mesmo local. Boa leitura!Edited by Office Editora e Publicidade Ltda, 01/2012; , ISBN: 978-85-87181-26-8
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ABSTRACT: Background and purposeIn elite athletes, osteitis pubis is a common painful degenerative process of the pubic symphysis and surrounding soft tissues and tendons. We report the diagnostic pathway and the rehabilitation protocol of six elite athletes with osteitis pubis in three different sports, and compare protocol stages and time to return to competition.Methods6 athletes (2 soccer, 2 basketball, 2 rugby players) were diagnosed with osteitis pubis stage III and IV according to Rodriguez classification using standard clinical and imaging criteria. After performing a baseline lumbo-pelvic assessment, the rehabilitation protocol described by Verrall was adapted to each individual athlete.ResultsThe length of time for each stage of the protocol was as follows; Stage 1 (rest from sport) was 26 +/− 5 days, Stage 2 (to achieve pain free running), 18 +/− 5 days, Stage 3 (squad training) 63 +/− 7, Stage 4 (return to competition) 86 +/− 15. Soccer players took longer to return to competition than basketball and rugby players. No recurrences were reported at 2 year follow-up.ConclusionThe protocol presented ensures a safe return to elite athletes. The time from diagnosis to full recovery is longer in football players, and seems to increase with age.09/2014; 10:52-8.
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ABSTRACT: Hip disorder patients typically present with extensive pain referral and hyperalgesia. To better understand underlying mechanisms an experimental hip pain model was established where pain referrals and hyperalgesia could be studied under standardized conditions. In sixteen healthy subjects, pain was induced by hypertonic saline injection into the gluteus medius tendon (GMT), addutor longus tendon (ALT), or gluteus medius muscle (GMM). Isotonic saline was injected contralaterally as control. Pain intensity was assessed on a visual analogue scale (VAS) and subjects mapped the pain distribution. Before, during and after injections, passive hip joint pain provocation tests were completed together with quantitative sensory testing: Pressure pain thresholds (PPTs), cuff algometry pain thresholds (cuff-PPTs), cutaneous pin-prick sensitivity, and thermal pain thresholds. Hypertonic saline injected into the GMT caused higher VAS scores than hypertonic injections into the ALT and GMM (P<0.05). Referred pain areas spread to larger parts of the leg after GMT and GMM injections compared with more regionalized pain pattern after ALT injections (P<0.05). PPTs at the injection site were decreased after hypertonic saline injections into GMT and GMM compared with baseline, ALT injections, and isotonic saline. Cuff-PPTs from the thigh were decreased after hypertonic saline injections into the ALT compared with baseline, GMT injections, and isotonic saline (P<0.05). More subjects had positive joint pain provocation tests after hypertonic compared with isotonic saline injections (P<0.05) indicating that this provocation test also assess hyperalgesia in extra-articular soft tissues. The experimental models may open for better understanding of pain mechanisms associated with painful hip disorders.Pain 01/2014; 155(4). DOI:10.1016/j.pain.2014.01.008 · 5.84 Impact Factor