Groin pain: clinical assessment and the role of MR imaging

Groin pain is a common problem in the elite athlete and may lead to prolonged inactivity if inadequately treated. Groin pain, arising from injuries to the hip and pelvis, accounts for 5 to 6% of athletic injuries in adults and 10 to 24% of these injuries in children. Lower limb-dominated athletic activities such as football, rugby, ice hockey, running, and ballet are particularly at risk. Comprehensive evaluation of all the anatomical locations prone to injury including the hip joint, sacrum, ilium and proximal femora, pelvic tendon attachments, and pelvic musculature is required. Magnetic resonance (MR) imaging provides superb soft tissue contrast resolution, multiplanar capabilities, and a wide field of view to evaluate many potential causes of groin pain. Careful clinical examination allows the optimal use of MR imaging and MR arthrography to evaluate the articular, osseous, tendinous, and muscular structures, which may be the source of groin pain. Accurate diagnosis is essential for appropriate management and rehabilitation plans. This article reviews the role of clinical assessment in guiding diagnostic imaging and also describes the relevant MR imaging findings in athletes presenting with groin pain.