Gerald T. Fon

Diagnostic and Prognostic Value of Clinical Findings in 83 Athletes with Posterior Thigh Injury Comparison of Clinical Findings with Magnetic Resonance Imaging Documentation of Hamstring Muscle Strain

Background Little is known about the clinical features of posterior thigh injuries and their contribution to accurate diagnosis and prognostic assessment of hamstring muscle strain injury. Hypotheses The clinical features of posterior thigh injury can be used to diagnose hamstring muscle strain and to predict duration of absence from competition. Study Design Prospective clinical study. Methods For two playing seasons, the clinical features of posterior thigh injury, timing of injury, and playing days lost were recorded for Australian Rules football players. Magnetic resonance imaging was used to confirm hamstring muscle injury. Results Posterior thigh injuries associated with pain and tenderness were recorded for 83 players, with magnetic resonance imaging confirming hamstring injury in 68 (82%). Most of the hamstring injuries were sudden onset (62; 91%) and occurred after a significant warm-up period (57; 84%). Of the patients whose injuries were sudden onset and occurred after the warm-up period (N = 59), 57 (97%) had hamstring muscle strain detected on magnetic resonance imaging. Hamstring muscle injury confirmed by magnetic resonance imaging was associated with a longer absence from competition (mean, 27 days) than injuries where no hamstring injury was detected (mean, 16 days). Conclusions The clinical features of hamstring injury typically include sudden onset, pain, and tenderness, although exceptions do occur. Muscle fatigue may be important in the pathogenesis of hamstring injury.

Hip joint range of motion reduction in sports-related chronic groin injury diagnosed as pubic bone stress injury

Traumatic osteitis pubis is a non-specific entity that relates to chronic groin injury and has recently been described as being akin to a pubic bone stress injury. It is uncertain whether or not reduction of hip joint range of motion occurs in traumatic osteitis pubis. The purpose of this study was to establish whether there is a reduction of hip range of motion in athletes who have chronic groin injury diagnosed as pubic bone stress injury. A case-control study was performed whereby 89 Australian Rules footballers underwent, with clinical history unknown, clinical and MRI examination of the groin region. Clinical criteria (pain with tenderness) and MR-criteria (pubic bone marrow oedema) were used for diagnosis of pubic bone stress injury. End-range internal and external rotation hip motion was measured using a goniometer. Athletes with and without symptoms were compared, as were athletes with current symptoms with athletes who had recovered from their groin pain episode. Chronic groin injury was diagnosed in 47 athletes with 37 having pubic bone stress injury. Thirteen athletes had previous groin injury. A reduction of internal and external hip range of motion was demonstrated in athletes with pubic bone stress injury (p < 0.05) and in athletes who had current symptoms compared to those who had recovered from their groin pain episode (p < 0.05). A reduction in hip range of motion was evident in athletes with chronic groin injury diagnosed as pubic bone stress injury. There may be a role for increasing hip range of motion in rehabilitation.

Description of pain provocation tests used for the diagnosis of sports‐related chronic groin pain: relationship of tests to defined clinical (pain and tenderness) and MRI (pubic bone marrow oedema) criteria

The clinical assessment of groin pain in athletes is difficult, with the lack of specific clinical tests being in part responsible. Three pain provocation tests used in the diagnosis of chronic groin pain are described and their relationship to defined clinical and MRI criteria has been assessed.

Groin Pain in Footballers The Association Between Preseason Clinical and Pubic Bone Magnetic Resonance Imaging Findings and Athlete Outcome

Background Groin pain and tenderness are common in athletes from a variety of codes of football, but little attention has been directed to the influence of magnetic resonance imaging and such clinical findings on athlete participation. Hypothesis Preseason groin pain, tenderness, and magnetic resonance imaging findings such as pubic bone marrow edema are associated with restricted training capacity and missed games. Study Design Cohort study; Level of evidence, 2. Methods Fifty-two Australian footballers in the national competition were recruited. Preseason groin pain and focal tenderness were recorded, and magnetic resonance imaging of the groin was performed within 1 week of examination. Training restriction and games missed owing to groin pain were documented during the subsequent season. Results Magnetic resonance imaging showed pubic bone marrow edema in 19 of 52 (37%) footballers and linear parasymphyseal T2 hyperintensity in 16 of 52 (31%) footballers. Groin pain restricted training during the season in 22 of 52 (42%) footballers, and 9 of 52 (17%) footballers missed at least 1 game. Preseason pain (P =. 0004), pubic bone tenderness (P =. 02), and linear parasymphyseal T2 hyperintensity (P =. 01) were associated with restricted training capacity during the subsequent season. Preseason groin pain (P =. 03) was associated with missed games, but magnetic resonance imaging findings were not. Conclusion Preseason pubic bone marrow edema, groin pain, and linear parasymphyseal T2 hyperintensity were associated with training restriction, but only preseason groin pain was associated with missed games.

Outcome of Conservative Management of Athletic Chronic Groin Injury Diagnosed as Pubic Bone Stress Injury

Background Little data exist on the results of treatment for sports-related chronic groin injury. Hypothesis Sports-related chronic groin injury treated with a conservative (rest) program results in a satisfactory outcome. Study Design Case series; Level of evidence, 4. Methods Professional Australian male football players, at the end of the playing season, had their groin injury diagnosed using specific clinical and magnetic resonance imaging (MRI) criteria. Those assessed as having a non-hip-related cause for their chronic groin injury were treated principally by 12 weeks of complete rest from active weightbearing activities. Response to treatment was assessed at different stages of rehabilitation by recording the number of athletes who had returned to playing football and the number of athletes without symptoms. Results Twenty-seven athletes were considered to have chronic groin injury. Clinical and MRI (pubic bone marrow edema N = 26 [96%]), hyperintense line N = 25 [93%]) criteria suggested a pubic bone stress injury as diagnosis for the chronic groin injury. Eighty-nine percent of athletes returned to sport in the subsequent playing season, with 100% having returned by the second playing season after diagnosis. Forty-one percent of the athletes were without symptoms at the commencement of the following playing season, rising to 67% by the end of that playing season. Conclusions Conservative management of athletic chronic groin injury resulted in an excellent outcome when assessed by the return to sport criterion. However, the results were only satisfactory if the criterion of ongoing symptoms after treatment was used. More research is needed to compare the efficacy of all treatments that are used in this troublesome condition.

The appearances of lumbar intraspinal synovial cysts

Intraspinal synovial cysts most commonly occur in the lower lumbar spine and may cause radicular symptoms. Eight symptomatic patients are described, each of whom had a single synovial cyst with associated facet joint degeneration. Four were at the L4-5 level and two each at L3-4 and L5-S1. Myelography in four patients revealed a posterolateral indentation on the contrast column in each case. Computed tomography (CT) revealed a structure of similar or greater density than the thecal sac in six cases and of gas density in one case. Two of the former cases also contained gaseous elements, three cases had a mildly dense rim and in the eighth case calcification was demonstrated within the cyst. One cyst resolved after facet joint injection with local anaesthetic and steroid.

A randomized double-blind trial of ioversol and iopamidol in contrast-enhanced computed body tomography.

The authors compared iopamidol and ioversol in a double-blind study conducted on 81 patients (ioversol in 40 patients; iopamidol in 41 patients) undergoing computed body tomography (CT) for a variety of indications at the Flinders Medical Centre in South Australia. Each study was assessed for image quality and rated as diagnostic or nondiagnostic. Patients were monitored for blood pressure measurement, pulse rate, and respiration rate before and after contrast administration and were observed for the occurrence of side effects. Subjective assessments of heat and pain sensations also were obtained from the patients. With the exception of one patient studied with iopamidol, all investigations were rated as either good or excellent. In all cases, the examination was considered diagnostic. No adverse reactions were noted after administration of either contrast material, except in one patient who felt nauseated. Because the patient had reported feeling nauseated before the examination, this side effect was considered to be coincidental. One patient experienced mild pain from injection of iopamidol. In no cases were any drug-related or clinically significant changes in vital signs noted. In this study, both iopamidol and ioversol were well tolerated and effective, with few side effects after intravenous administration for contrast enhancement during whole-body CT.