Summary

A descriptive study about MRI indirect radiological signs of sport hernia in a sportive population with groin pain syndrome

Abstract

ABSTRACT.

Sport hernia (SH) is one of the most frequent inguinal pathologies in athletes (1). The golden examination for SH assessment hernia is dynamic ultrasound (2) (DUS). However, DUS examination is very dependent on operator skill and often the presence of a SH can be misunderstood. Especially in difficult cases or in cases of dubious interpretation of DUS images the RMI examination may furnish an important help. The purpose of this study is to establish a possible relationship between SH and some indirect radiological sign recorded during MRI examination.

INTRODUCTION.

SH is a pain syndrome of the lower abdomen and groin. From anatomical point of view SH is a weakness or a bulging of the posterior wall of the inguinal canal which can be coupled with micro-tears of conjoint tendon and / or inguinal ligament (1). During the DUS assessment SH is detectable as a flattening or an inversion of the physiological concavity of the posterior wall of the inguinal canal (1,3). The detection of SH request a specific operator skill and , for this reason, many times the presence of SH may be misunderstood. However, into the MRI examination often are present some radiological signs that typically are associated with the presence of a SH (4). For this reason the MRI examination may represent an important help into the detection of SH and can support the DUS examination especially into the cases in which is present a dubious interpretation.

Materials And Methods

In this study we considered 51 patients (48 men and 3 women), all the subjects practiced sport activities and complained a groin pain syndrome (GPS) from in average 9.6 ±6.3 months (range 3 -18 months). All patients were examined by a single experienced sports medicine physician and by an abdominal surgeon in conformity with the clinical examination protocol established during the first Groin Pain Syndrome Italian Consensus Conference on terminology, clinical evaluation and imaging assessment in groin pain in athletes (GPSICC) (1). All the subject performed a DUS from the same radiologist and an MRI evaluation of the pelvis still in conformity with the protocol established during the GPSICC (1).

Results

During the DUS examination all the subjects showed radiological sign of SH (i.e. flattening or inversion of the physiological concavity of the posterior wall of the inguinal canal). During the MRI examination was recorded the following radiological signs:

i. Protrusion of the symphysis central disc (PCD) in 52.9% of the cases.
ii. Tendinopathy at adductor longus level (TAL) in 45.1 of the cases.
iii. Sclerosis of pubic symphysis (SPS) in 45.1% of the cases.
iv. Sub-condral cyst at pubic symphysis level (SCC) in 25.5% of the cases.
v. Bone marrow edema (BME) at pubic symphysis level in 25.5% of the cases.

Discussion

In our series some radiological sign recorded during MRI examination are strongly correlated with SH. Since the presence of SH is caused by an hypermobility of pubic symphysis it is logical to find some radiological signs that are connected to this joint hypermobility (1,3). The presence of this signs on MRI examination can thus further confirm, or make highly suspect in doubtful cases, the presence of SH

Conclusions

Some radiological signs - in special manner the presence of PDC, TAL and SPS and in secondary manner the presence of SSC and BME – are strongly associated with the presence of SH and for this reason may represent an important radiological findings in the GPS caused by inguinal pathologies.