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: Suzan De Jonge
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- "In this study, use of one or two injections in the pubic symphisis allowed seven out of eight athletes to return to sporting activities after conservative treatment with rest, oral anti-inflammatory medication and hip stretching exercises had failed. A recent non-randomized study examining the effects of an entheseal pubic cleft injection with a local anesthetic and corticosteroid reported good results up to 1 year in a group of patients without magnetic resonance imaging (MRI) abnormalities at the adductor enthesis (Schilders et al., 2007). "
ABSTRACT: The objective was to retrospectively examine whether a manual therapy technique is effective in the treatment of chronic adductor-related groin pain in athletes. Thirty-three athletes with chronic adductor-related groin pain were approached. Thirty patients gave their consent to participate in the study. Patient satisfaction, return to activity and numeric pain score were recorded. Patients were treated after prewarming of the muscles; one hand is used to control the tension in the adductor muscles and the other hand is used to move the hip into abduction and external rotation. This flowing, circular motion stretches the adductor muscle group. The movement is repeated three times in one treatment session. Twenty-five out of 30 (83%) athletes reported a good or excellent satisfaction. Twenty-seven out of 30 (90%) athletes had resumed sport at (15/30) or below (12/30) their previous level of activity. The pain score for during or after activity decreased significantly from 8.7 to 2.2 after the treatment (P<0.01). This study shows that the manual therapy treatment might be a promising treatment for chronic adductor-related groin pain in athletes.Scandinavian Journal of Medicine and Science in Sports 08/2008; 19(5):616-20. DOI:10.1111/j.1600-0838.2008.00841.x · 3.17 Impact Factor
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