Pubic apophysitis: a previously undescribed clinical entity of groin pain in athletes
Background Sport-related pubalgia is often a diagnostic challenge in elite athletes. While scientific attention has focused on adults, there is little data on adolescents. Cadaveric and imaging studies identify a secondary ossification centre located along the anteromedial corner of pubis beneath th...
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Published in | British journal of sports medicine Vol. 49; no. 12; pp. 828 - 834 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
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BMJ Publishing Group
01.06.2015
BMJ Publishing Group LTD |
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Abstract | Background Sport-related pubalgia is often a diagnostic challenge in elite athletes. While scientific attention has focused on adults, there is little data on adolescents. Cadaveric and imaging studies identify a secondary ossification centre located along the anteromedial corner of pubis beneath the insertions of symphysial joint capsule and adductor longus tendon. Little is known about this apophysis and its response to chronic stress. Aim We report pubic apophysitis as a clinically relevant entity in adolescent athletes. Methods The clinical and imaging findings in 26 highly trained adolescent football players (15.6 years±1.3) who complained of adductor-related groin pain were reviewed. The imaging features (X-ray 26/26, US 9/26, MRI 11/26, CT 7/26) of the pubic apophyses in this symptomatic group were compared against those of a comparison group of 31 male patients (age range 9–30 years) with no known history of groin pain or pelvic trauma, who underwent pelvic CT scans for unrelated medical reasons. Results All symptomatic subjects presented with similar history and physical findings. The CT scans of these patients demonstrated open pubic apophyses with stress-related physeal changes (widening, asymmetry and small rounded cyst-like expansions) that were not observed in the comparison group. No comparison subject demonstrated apophyseal maturity before 21 years of age, and immaturity was seen up to the age of 26 years. Conclusions This retrospective case series identifies pubic apophyseal stress (or ‘apophysitis’) as an important differential consideration in the adolescent athlete who presents with groin pain. |
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AbstractList | Sport-related pubalgia is often a diagnostic challenge in elite athletes. While scientific attention has focused on adults, there is little data on adolescents. Cadaveric and imaging studies identify a secondary ossification centre located along the anteromedial corner of pubis beneath the insertions of symphysial joint capsule and adductor longus tendon. Little is known about this apophysis and its response to chronic stress. We report pubic apophysitis as a clinically relevant entity in adolescent athletes. The clinical and imaging findings in 26 highly trained adolescent football players (15.6 years±1.3) who complained of adductor-related groin pain were reviewed. The imaging features (X-ray 26/26, US 9/26, MRI 11/26, CT 7/26) of the pubic apophyses in this symptomatic group were compared against those of a comparison group of 31 male patients (age range 9-30 years) with no known history of groin pain or pelvic trauma, who underwent pelvic CT scans for unrelated medical reasons. All symptomatic subjects presented with similar history and physical findings. The CT scans of these patients demonstrated open pubic apophyses with stress-related physeal changes (widening, asymmetry and small rounded cyst-like expansions) that were not observed in the comparison group. No comparison subject demonstrated apophyseal maturity before 21 years of age, and immaturity was seen up to the age of 26 years. This retrospective case series identifies pubic apophyseal stress (or 'apophysitis') as an important differential consideration in the adolescent athlete who presents with groin pain. Sport-related pubalgia is often a diagnostic challenge in elite athletes. While scientific attention has focused on adults, there is little data on adolescents. Cadaveric and imaging studies identify a secondary ossification centre located along the anteromedial corner of pubis beneath the insertions of symphysial joint capsule and adductor longus tendon. Little is known about this apophysis and its response to chronic stress. We report pubic apophysitis as a clinically relevant entity in adolescent athletes. The clinical and imaging findings in 26 highly trained adolescent football players (15.6 years plus or minus 1.3) who complained of adductor-related groin pain were reviewed. The imaging features (X-ray 26/26, US 9/26, MRI 11/26, CT 7/26) of the pubic apophyses in this symptomatic group were compared against those of a comparison group of 31 male patients (age range 9-30 years) with no known history of groin pain or pelvic trauma, who underwent pelvic CT scans for unrelated medical reasons. All symptomatic subjects presented with similar history and physical findings. The CT scans of these patients demonstrated open pubic apophyses with stress-related physeal changes (widening, asymmetry and small rounded cyst-like expansions) that were not observed in the comparison group. No comparison subject demonstrated apophyseal maturity before 21 years of age, and immaturity was seen up to the age of 26 years. This retrospective case series identifies pubic apophyseal stress (or 'apophysitis') as an important differential consideration in the adolescent athlete who presents with groin pain. BACKGROUNDSport-related pubalgia is often a diagnostic challenge in elite athletes. While scientific attention has focused on adults, there is little data on adolescents. Cadaveric and imaging studies identify a secondary ossification centre located along the anteromedial corner of pubis beneath the insertions of symphysial joint capsule and adductor longus tendon. Little is known about this apophysis and its response to chronic stress.AIMWe report pubic apophysitis as a clinically relevant entity in adolescent athletes.METHODSThe clinical and imaging findings in 26 highly trained adolescent football players (15.6 years ± 1.3) who complained of adductor-related groin pain were reviewed. The imaging features (X-ray 26/26, US 9/26, MRI 11/26, CT 7/26) of the pubic apophyses in this symptomatic group were compared against those of a comparison group of 31 male patients (age range 9-30 years) with no known history of groin pain or pelvic trauma, who underwent pelvic CT scans for unrelated medical reasons.RESULTSAll symptomatic subjects presented with similar history and physical findings. The CT scans of these patients demonstrated open pubic apophyses with stress-related physeal changes (widening, asymmetry and small rounded cyst-like expansions) that were not observed in the comparison group. No comparison subject demonstrated apophyseal maturity before 21 years of age, and immaturity was seen up to the age of 26 years.CONCLUSIONSThis retrospective case series identifies pubic apophyseal stress (or 'apophysitis') as an important differential consideration in the adolescent athlete who presents with groin pain. Background Sport-related pubalgia is often a diagnostic challenge in elite athletes. While scientific attention has focused on adults, there is little data on adolescents. Cadaveric and imaging studies identify a secondary ossification centre located along the anteromedial corner of pubis beneath the insertions of symphysial joint capsule and adductor longus tendon. Little is known about this apophysis and its response to chronic stress. Aim We report pubic apophysitis as a clinically relevant entity in adolescent athletes. Methods The clinical and imaging findings in 26 highly trained adolescent football players (15.6 years±1.3) who complained of adductor-related groin pain were reviewed. The imaging features (X-ray 26/26, US 9/26, MRI 11/26, CT 7/26) of the pubic apophyses in this symptomatic group were compared against those of a comparison group of 31 male patients (age range 9-30 years) with no known history of groin pain or pelvic trauma, who underwent pelvic CT scans for unrelated medical reasons. Results All symptomatic subjects presented with similar history and physical findings. The CT scans of these patients demonstrated open pubic apophyses with stress-related physeal changes (widening, asymmetry and small rounded cyst-like expansions) that were not observed in the comparison group. No comparison subject demonstrated apophyseal maturity before 21 years of age, and immaturity was seen up to the age of 26 years. Conclusions This retrospective case series identifies pubic apophyseal stress (or 'apophysitis') as an important differential consideration in the adolescent athlete who presents with groin pain. Sport-related pubalgia is often a diagnostic challenge in elite athletes. While scientific attention has focused on adults, there is little data on adolescents. Cadaveric and imaging studies identify a secondary ossification centre located along the anteromedial corner of pubis beneath the insertions of symphysial joint capsule and adductor longus tendon. Little is known about this apophysis and its response to chronic stress. We report pubic apophysitis as a clinically relevant entity in adolescent athletes. The clinical and imaging findings in 26 highly trained adolescent football players (15.6 years ± 1.3) who complained of adductor-related groin pain were reviewed. The imaging features (X-ray 26/26, US 9/26, MRI 11/26, CT 7/26) of the pubic apophyses in this symptomatic group were compared against those of a comparison group of 31 male patients (age range 9-30 years) with no known history of groin pain or pelvic trauma, who underwent pelvic CT scans for unrelated medical reasons. All symptomatic subjects presented with similar history and physical findings. The CT scans of these patients demonstrated open pubic apophyses with stress-related physeal changes (widening, asymmetry and small rounded cyst-like expansions) that were not observed in the comparison group. No comparison subject demonstrated apophyseal maturity before 21 years of age, and immaturity was seen up to the age of 26 years. This retrospective case series identifies pubic apophyseal stress (or 'apophysitis') as an important differential consideration in the adolescent athlete who presents with groin pain. |
Author | Read, John W Hölmich, Per Giuffre, Bruno Whiteley, Rod Sailly, Matthieu Johnson, Amanda |
AuthorAffiliation | 7 Aspetar Sports Groin Pain Center, Qatar Orthopaedic and Sports Medicine Hospital , Doha , Qatar 6 University of Manchester , Manchester , UK 9 Copenhagen University Hospital , Amager-Hvidovre , Denmark 3 University of Sydney , Sydney, New South Wales , Australia 8 Arthroscopic Center Amager, Sports Orthopedic Research Center , Copenhagen , Denmark 2 Aspetar Orthopaedic and Sports Medicine Hospital , Doha , Qatar 5 Radiology Department , Royal North Shore Hospital , Sydney, New South Wales , Australia 1 Centre Medical Synergie , Lausanne , Switzerland 4 Castlereagh Imaging , St Leonards , Australia |
AuthorAffiliation_xml | – name: 7 Aspetar Sports Groin Pain Center, Qatar Orthopaedic and Sports Medicine Hospital , Doha , Qatar – name: 3 University of Sydney , Sydney, New South Wales , Australia – name: 9 Copenhagen University Hospital , Amager-Hvidovre , Denmark – name: 4 Castlereagh Imaging , St Leonards , Australia – name: 2 Aspetar Orthopaedic and Sports Medicine Hospital , Doha , Qatar – name: 1 Centre Medical Synergie , Lausanne , Switzerland – name: 5 Radiology Department , Royal North Shore Hospital , Sydney, New South Wales , Australia – name: 8 Arthroscopic Center Amager, Sports Orthopedic Research Center , Copenhagen , Denmark – name: 6 University of Manchester , Manchester , UK |
Author_xml | – sequence: 1 givenname: Matthieu surname: Sailly fullname: Sailly, Matthieu email: matthieusailly@yahoo.fr organization: Centre Medical Synergie, Lausanne, Switzerland – sequence: 2 givenname: Rod surname: Whiteley fullname: Whiteley, Rod email: matthieusailly@yahoo.fr organization: University of Sydney, Sydney, New South Wales, Australia – sequence: 3 givenname: John W surname: Read fullname: Read, John W email: matthieusailly@yahoo.fr organization: Castlereagh Imaging, St Leonards, Australia – sequence: 4 givenname: Bruno surname: Giuffre fullname: Giuffre, Bruno email: matthieusailly@yahoo.fr organization: Radiology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia – sequence: 5 givenname: Amanda surname: Johnson fullname: Johnson, Amanda email: matthieusailly@yahoo.fr organization: University of Manchester, Manchester, UK – sequence: 6 givenname: Per surname: Hölmich fullname: Hölmich, Per email: matthieusailly@yahoo.fr organization: Copenhagen University Hospital, Amager-Hvidovre, Denmark |
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Snippet | Background Sport-related pubalgia is often a diagnostic challenge in elite athletes. While scientific attention has focused on adults, there is little data on... Sport-related pubalgia is often a diagnostic challenge in elite athletes. While scientific attention has focused on adults, there is little data on... BACKGROUNDSport-related pubalgia is often a diagnostic challenge in elite athletes. While scientific attention has focused on adults, there is little data on... |
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SubjectTerms | Abdominal Pain - etiology Abdominal Pain - pathology Abdominal Pain - rehabilitation Adolescent Arthritis - complications Arthritis - pathology Arthritis - rehabilitation Asymptomatic Athletes Case-Control Studies Child Child development Football Groin - pathology Hip joint Humans Magnetic Resonance Imaging Male Medical imaging Original Pain Pathology Pelvis Physical Examination Pubic Symphysis - pathology Soccer - physiology Sports injuries Sports medicine Stress Teenagers Tomography, X-Ray Computed Ultrasonic imaging |
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Title | Pubic apophysitis: a previously undescribed clinical entity of groin pain in athletes |
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