Longstanding groin pain in athletes. A multidisciplinary approach.

Ekberg O, Persson NH, Abrahamsson PA, Westlin NE, Lilja B. Sports Med 1988 Jul;6(1):56-61.

In 21 male athletes (age 20 to 40 years) with longstanding unexplained groin pain, a multidisciplinary investigation was performed in order to reveal the underlying cause. These examinations included general surgery for detection of inguinal hernia and neuralgia, orthopaedic surgery for detection of adductor tenoperiostitis and symphysitis, urology for detection of prostatitis, radiology for performing herniography and plain film of the pelvic bones, nuclear medicine for isotope studies of the pubic bone and symphysis. In 19 patients there was a positive diagnosis for 2 or more of the diseases (10 patients had 2 diseases, 6 patients had 3 diseases, 3 patients had 4 diseases). Two patients had only signs of symphysitis. Our results show the complexity of longstanding groin pain in athletes. It also explains why therapy for one specific disease entity may fail. We conclude that this clinical setting demands the recruitment of a team with experience of different aspects of groin pain.

Legg-Calve-Perthes’ disease.

Wall EJ. Curr Opin Pediatr 1999 Feb;11(1):76-9.

The etiology, radiographic classification, and treatment of Legg-Calve-Perthes’ disease remain controversial. Several recent papers focus on these issues in an effort to provide guidance in the clinical care of Perthes’ disease. The research studied in this paper lends further support to the hypothesis of clotting abnormalities with vascular thrombosis, which seems to be the most likely etiology for Legg-Calve-Perthes’ disease. Several studies focus on use of magnetic resonance imaging for the early diagnosis and prognosis of Perthes’ disease. A few researchers whose work is featured in this paper add information on the treatment of Perthes’ disease, supporting surgical treatment for older patients with more severe disease and non-surgical treatment for younger patients with less extensive femoral head involvement.

Diagnosis and treatment of slipped capital femoral epiphysis.

Reynolds RA. Curr Opin Pediatr 1999 Feb;11(1):80-3
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Slipped capital femoral epiphysis remains a diagnostic problem despite numerous papers written on the subject. The most important factor in the diagnosis of slipped capital femoral epiphysis is suspicion by the practitioner. The history, physical examination, and radiographic imaging are important in the confirmation of the diagnosis. Imaging is the topic of 1998 with advances in the areas of ultrasound. Ultrasound may be better in experienced hands than plain radiography in the diagnosis of slipped capital femoral epiphysis. Magnetic resonance imaging is used for diagnosis of slipped capital femoral epiphysis and in the assessment of pre-slips. The magnetic resonance image can be oriented to a plane orthoganol to the plane of the physis to assess the width of the physis and to detect edema in the area of the physis.

Hip pain in athletes.

Adkins SB 3rd, Figler RA. Am Fam Physician 2000 Apr 1;61(7):2109-18.

Hip pain in athletes involves a wide differential diagnosis. Adolescents and young adults are at particular risk for various apophyseal and epiphyseal injuries due to lack of ossification of these cartilaginous growth plates. Older athletes are more likely to present with tendinitis in these areas because their growth plates have closed. Several bursae in the hip area are prone to inflammation. The trochanteric bursa is the most commonly injured, and the lesion is easily identified by palpation of the area. Iliotibial band syndrome presents with similar lateral hip pain and may be identified by provocative testing (Ober’s test). A methodical physical examination that specifically tests the various muscle groups that move the hip joint can help determine a more specific diagnosis for the often vague complaint of hip pain. A number of hip conditions are more prevalent in athletes of certain ages. Transient synovitis is a common diagnosis in the very young, Legg-Calve-Perthes disease causes bony disruption of the femoral head in prepubescents, and slipped capital femoral epiphysis is seen most commonly in obese adolescent males. Femoral neck stress fractures are seen in adult athletes, especially those involved in endurance sports, and can progress to necrosis of the femoral head if not found early. Older athletes may be limited by degenerative joint disease but nonetheless should be encouraged to stay active.