Francis William Smith MD, Presenter: Nothing to Disclose

The diagnosis of the cause of groin pain is critical in the management of athletes with this complaint. Clinically the diagnosis of conjoint tendinitis is often over diagnosed, resulting in unecessary surgery. To evaluate the value of MRI of the pelvis in athletes complaining of groin pain the MRI scans of 127 male athletes aged 11 - 30 years were reviewed.

178 male athletes, ranging from school boy to international level aged 11 - 30 years were studied. Each had been referred complaining of groin pain of greater than three weeks. All were examined using a 0.2T open MRI system [Seimens Erlangen]. Tansverse T1 &T2 weighted images aswell as Coronal STIR, and offset coronal T2 & STIR images along the line of the inferior pubic rami were made.

In 63 cases [50%] no abnornmality was found. There were 19 cases of osteitis pubis, 9 cases of stress fracture [ 8 of the inferior pubic ramus and one of the femoral neck], 5 cases of adductor muscle tear, 6 with hamstring muscle tear, 10 with inflammation of the small rotator muscles of the hip and 4 cases of ilio-psoas tendinitis. The remaining 11 cases had various other findings including 2 bone tumours {one osteochondroma and one fibrous dysplasia]. None showed evidence of conjoint tendinitis.The stress fractures and adductor muscle tears were best demonstrated on the offset coronal T2 and STIR images.

Conjoint tendinitis is often over diagnosed and careful MRI examination of the pelvis is important for athletes with groin pain. The use of offset coronal images to better visualise the inferior pubic rami adds important information when imaging the pelvis for groin pain.

Smith, F, The Value of MRI in the Investigation of Groin Pain in Male Athletes.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4415049.html