BACKGROUND & OBJECTIVE
Under the umbrella of groin pain often it is the adductors that are investigated, but are the hip flexors being overlooked? Hip and groin injuries are complex, and objective assessments of the hip flexors often produce inaccurate differential diagnosis with multiple positive tests. The complex interactions of the musculotendinous junction (MTJ) and split tendons of rectus femoris (direct & indirect heads) and iliopsoas tendons contribute to this inaccuracy. Better appreciation of the radiographical presentation following hip flexor injury may help to improve our understanding of injury mechanisms and injury incidence. This study aimed to describe hip flexor-related groin pain and identify injury-related activities.
33 male athletes presented with acute groin pain, occurring within 7 days of assessment. Athletes were included from a range of sporting backgrounds (football, futsal, basketball, handball and beach football) and underwent a subjective assessment from a sports physician to detail injury history and mechanism. For the purpose of this study, no clinical/objective examination was reported. However the athletes were scanned using a 1.5-tesla system MRI.
Images were assessed by the same musculoskeletal radiographer and graded on an ordinal scale of 1-3: Grade 1: diffuse intramuscular oedema; Grade 2: disrupted architecture with oedema; Grade3: avulsion or complete musculotendinous disruption. 3-dimensional measurements of the amount of swelling were also recorded, as well as specific location of swelling, using the MTJ as a landmark for intramuscular tears.
Rectus femoris injuries accounted for 48% of hip-flexor related groin pain in this study, with 94% of these occurring in isolation. These injuries primarily occurred during kicking or sprinting. The locations could be divided into 5 common sites, with the