| This trial aimed to assess the value of MRI in the differential
diagnosis of chronic groin pain in athletes, a condition caused by
various pathologies, the most common being posterior abdominal wall
deficiency, osteitis pubis and muscular imbalance. Nineteen subjects
with clinically ruled-out hernia and recurrent episodes of exercise-triggered
groin pain were assessed. Dynamic MRI was performed under Valsalva
manoeuver and at rest within a training- free period and after training
activity. Follow-up was performed after 4 years using a questionnaire
and physical examination. An incipient hernia was seen in one case,
Valsalva manoeuver provoked a visible bulging in 7 others (3 bilateral).
Eight athletes showed symphysitis (accompanied by bulging in 3 cases).
MRI visualized one hydrocele, one osteoma of the left femur, one enchondroma
of the pubic bone, and one dilated left ureter without clinical symptoms
or therapeutic relevance. MRI findings after training and during the
training free period did not vary. Fifteen participants were available
for a follow-up control examination 4 years later - one suffered from
ongoing pain, eleven were free of symptoms and three had improvement.
However, most of them improved only with changing or reducing training.
There were four participants with a specific therapy of their MRI
findings. MRI revealed a variety of pathological findings in athletes
suffering from chronic groin pain, but it was not reliable enough
in differentiating between diagnoses requiring conservative or operative
treatment. The MRI examination within the training interval did not
have an advantage to that within the training-free period. Further
randomized prospective trials with a long follow-up should establish
whether MRI findings could be of help in the choice between conservative
and surgical treatment for chronic groin pain.
KEY
WORDS: MRI, hernia, athletes, chronic groin pain, symphysitis.
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