Use this link to view the PDF file: MR IMAGING OF ATHLETIC PUBALGIA: NORMAL ANATOMY, COMMON FINDINGS AND PITFALLS
Purpose: The purpose of this exhibit is to: 1) Understand the relevant normal anatomy of the pelvis with regards to athletic pubalgia on MRI, 2) Depict the spectrum of MRI findings in athletic pubalgia, and 3) Discuss common imaging pitfalls that may lead to erroneous diagnosis of athletic pubalgia in a specific subset of athletes.
Materials and Methods: We performed a retrospective database search of all collegiate and professional football players who underwent MRI of the pelvis with the athletic pubalgia protocol at our institution from 2010-2014. The MRI examinations were reviewed and findings seen in athletic pubalgia were evaluated. These included: 1) osteitis pubis, 2) the secondary cleft sign, 3) rectus abdominis tendinosis, tear or avulsion injury, 4) adductor longus tendinosis, tear or avulsion injury, and 5) aponeurotic injury or disruption. These findings were correlated with clinical examination, treatment and follow-up to confirm the diagnosis of athletic pubalgia. Additional findings on MRI of the pelvis were also noted that may present clinically as athletic pubalgia, such as inguinal hernia, hip joint chondral injury, labro-cartilaginous tear, avulsion injury of the anterior inferior iliac spine, iliopsoas bursitis, and hip joint osteoarthritis.
Results: The normal anatomy of pelvic MRI relevant to athletic pubalgia will be reviewed. We will present normal pubic symphysis anatomy including the fibro-cartilaginous disk, primary cleft and associated ligaments. A succinct approach to the anatomy of rectus abdominis, adductor longus, and common aponeurosis will be shown. Typical findings seen in athletic pubalgia in general, and those specifically relating to collegiate and professional football players will be discussed. Also, imaging findings of entities that were clinically misdiagnosed as athletic pubalgia will be included.
Conclusion: Athletic pubalgia is a common clinical diagnosis in collegiate and professional football players. A thorough understanding of the normal anatomy with appropriate protocol remains essential for MRI evaluation. An in-depth knowledge of typical findings as well common pitfalls seen in athletic pubalgia would assist in the early diagnosis of this condition, potentially preventing further injury or loss of playing time in this subset of athletes.