Radsource radiologists are constantly communicating and sharing knowledge with each other. In our new blog series, Today’s Interesting Case, our team will post notable cases and images for discussion from time to time.
A fat-suppressed T2-weighted coronal image showing a severe sports hernia
Today’s Interesting Case is from a 34 year-old hockey goalie who felt a pull when doing the splits during a game. MRI findings reveal a torn and retracted common adductor tendon in this dramatic example of a sports hernia (athletic pubalgia).
Dr. Michael Stadnick writes more about athletic pubalgia in the February 2010 web clinic. “Athletic pubalgia comprises a common group of injuries which potentially affect multiple musculotendinous and ligamentous structures of the pubic region. The complex, interrelated anatomy and the similarity of clinical symptoms often lead to diagnostic confusion.”
Dr. Stadnick makes the case for MRI diagnosis because “MRI allows direct visualization and assessment of the key anatomic structures in the pubic region, enabling a more focused treatment approach and improved outcomes for the affected athlete. ”
A proton density weighted sagittal image of the injury
He goes on to say that “Athletic pubalgia is a general term that encompasses a wide range of injuries at the symphysis pubis that share a similar injury mechanism and clinical presentation of exertional pubic and groin pain1. Groin pain most commonly develops insidiously, but may present acutely with a clinical history of a sudden tearing sensation. Symptoms are most often unilateral but may be bilateral. The patient typically experiences pain during exercise, complaining of discomfort in the inguinal region over the distal rectus abdominis, in the perineum, or radiating to the testicles. On physical examination, the patient may experience pain with resisted hip adduction or resisted sit-ups2. Local tenderness may be elicited at the attachments of the adductor longus or rectus abdominis or over the external inguinal ring, and Valsalva maneuver may cause pain.”
References
1. Omar IM, et al. Athletic Pubalgia and “Sports Hernia”:Optimal MR Imaging Technique and Findings. RadioGraphics2008;28:1415-1438.
2. Gamble JG, Simmons SC, Freedman M. The symphysis pubis: anatomic and pathologic considerations. Clin orthop Relat Res 1983;203:261-272.