Skip to main content
main-content
Erschienen in: Arthroskopie 2/2022

17.02.2022 | Femuroacetabuläres Impingement | Leitthema

Leistenschmerz beim Sportler

Was gibt es Neues?

verfasst von: Dr. med. Robert Lenz, Norman Holl, Christoph Lutter, Jens Krüger, Marc-André Weber, Thomas Tischer

Erschienen in: Arthroskopie | Ausgabe 2/2022

Einloggen, um Zugang zu erhalten

Zusammenfassung

Sportassoziierte Leistenschmerzen stellen ein häufiges und facettenreiches Problem insbesondere in Sportarten mit Rotationsbelastungen zwischen Rumpf und unterer Extremität dar. Die Vielzahl zugrundeliegender Ursachen und die Komplexität der anatomischen und biomechanischen Zusammenhänge der Leistenregion erfordern regelhaft eine fachübergreifende Abklärung. Die Identifikation der Schmerzursache gelingt meist nur durch eine gewissenhafte klinische Untersuchung und zielgerichtete weiterführende Diagnostik. Neben typischen Ursachen wie Adduktorenpathologien oder dem femoroazetabulären Impingement (FAI) müssen auch spezifische Befunde im Bereich der Leiste berücksichtigt werden (z. B. Osteitis pubis, Instabilitäten der Symphyse, Leistenkanalbrüche, Nervenengpasssyndrome etc.). Eine fokussierte Bildgebung kann jedoch unter Umständen schon früh Veränderungen der angrenzenden Weichteile als typische Ursache des Leistenschmerzes darstellen. Therapeutisch stehen in erster Linie konservative Ansätze mit dem Ziel eines Ausgleichs muskulärer Dysbalancen zur Verfügung. Abhängig von der einzelnen Entität können jedoch auch operative Maßnahmen, wie z. B. die Behandlung des FAI oder Pathologien des Leistenkanals, erforderlich werden. Aufgrund der Häufigkeit leistenassoziierter Pathologien bei Sportlern werden zukünftig auch präventive Aspekte mehr in den Fokus rücken müssen.
Literatur
1.
Zurück zum Zitat Muschaweck U, Koch A (2019) Sportsmen’s groin : definition, differential diagnosis and treatment. Radiologe 59(3):224–233 CrossRef Muschaweck U, Koch A (2019) Sportsmen’s groin : definition, differential diagnosis and treatment. Radiologe 59(3):224–233 CrossRef
3.
Zurück zum Zitat Weir A et al (2015) Doha agreement meeting on terminology and definitions in groin pain in athletes. Br J Sports Med 49(12):768–774 CrossRef Weir A et al (2015) Doha agreement meeting on terminology and definitions in groin pain in athletes. Br J Sports Med 49(12):768–774 CrossRef
4.
Zurück zum Zitat Birmingham PM et al (2012) The effect of dynamic femoroacetabular impingement on pubic symphysis motion: a cadaveric study. Am J Sports Med 40(5):1113–1118 CrossRef Birmingham PM et al (2012) The effect of dynamic femoroacetabular impingement on pubic symphysis motion: a cadaveric study. Am J Sports Med 40(5):1113–1118 CrossRef
5.
Zurück zum Zitat Hölmich P et al (1999) Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: randomised trial. Lancet 353(9151):439–443 CrossRef Hölmich P et al (1999) Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: randomised trial. Lancet 353(9151):439–443 CrossRef
6.
Zurück zum Zitat Werner J et al (2009) UEFA injury study: a prospective study of hip and groin injuries in professional football over seven consecutive seasons. Br J Sports Med 43(13):1036–1040 CrossRef Werner J et al (2009) UEFA injury study: a prospective study of hip and groin injuries in professional football over seven consecutive seasons. Br J Sports Med 43(13):1036–1040 CrossRef
7.
Zurück zum Zitat Werner J et al (2019) Hip and groin time-loss injuries decreased slightly but injury burden remained constant in men’s professional football: the 15-year prospective UEFA elite club injury study. Br J Sports Med 53(9):539–546 CrossRef Werner J et al (2019) Hip and groin time-loss injuries decreased slightly but injury burden remained constant in men’s professional football: the 15-year prospective UEFA elite club injury study. Br J Sports Med 53(9):539–546 CrossRef
8.
Zurück zum Zitat Schröder JH et al (2020) Diagnostic algorithm “FAI and sports hernia” : results of the consensus meeting for groin pain in athletes. Orthopade 49(3):211–217 CrossRef Schröder JH et al (2020) Diagnostic algorithm “FAI and sports hernia” : results of the consensus meeting for groin pain in athletes. Orthopade 49(3):211–217 CrossRef
9.
Zurück zum Zitat Robinson P et al (2007) Cadaveric and MRI study of the musculotendinous contributions to the capsule of the symphysis pubis. AJR Am J Roentgenol 188(5):W440–5 CrossRef Robinson P et al (2007) Cadaveric and MRI study of the musculotendinous contributions to the capsule of the symphysis pubis. AJR Am J Roentgenol 188(5):W440–5 CrossRef
10.
Zurück zum Zitat Brennan D et al (2005) Secondary cleft sign as a marker of injury in athletes with groin pain: MR image appearance and interpretation. Radiology 235(1):162–167 CrossRef Brennan D et al (2005) Secondary cleft sign as a marker of injury in athletes with groin pain: MR image appearance and interpretation. Radiology 235(1):162–167 CrossRef
11.
Zurück zum Zitat Schilders E et al (2017) The pyramidalis-anterior pubic ligament-adductor longus complex (PLAC) and its role with adductor injuries: a new anatomical concept. Knee Surg Sports Traumatol Arthrosc 25(12):3969–3977 CrossRef Schilders E et al (2017) The pyramidalis-anterior pubic ligament-adductor longus complex (PLAC) and its role with adductor injuries: a new anatomical concept. Knee Surg Sports Traumatol Arthrosc 25(12):3969–3977 CrossRef
12.
Zurück zum Zitat De Maeseneer M et al (2019) MR imaging-anatomical-histological evaluation of the abdominal muscles, aponeurosis, and adductor tendon insertions on the pubic symphysis: a cadaver study. Eur J Radiol 118:107–113 CrossRef De Maeseneer M et al (2019) MR imaging-anatomical-histological evaluation of the abdominal muscles, aponeurosis, and adductor tendon insertions on the pubic symphysis: a cadaver study. Eur J Radiol 118:107–113 CrossRef
13.
Zurück zum Zitat Riff AJ et al (2019) Surface mapping of the musculotendinous attachments at the pubic symphysis in cadaveric specimens: implications for the treatment of core muscle injury. Arthroscopy 35(8):2358–2364 CrossRef Riff AJ et al (2019) Surface mapping of the musculotendinous attachments at the pubic symphysis in cadaveric specimens: implications for the treatment of core muscle injury. Arthroscopy 35(8):2358–2364 CrossRef
14.
Zurück zum Zitat Dupré T et al (2018) Does inside passing contribute to the high incidence of groin injuries in soccer? A biomechanical analysis. J Sports Sci 36(16):1827–1835 CrossRef Dupré T et al (2018) Does inside passing contribute to the high incidence of groin injuries in soccer? A biomechanical analysis. J Sports Sci 36(16):1827–1835 CrossRef
15.
Zurück zum Zitat Wörner T, Thorborg K, Eek F (2019) Five-second squeeze testing in 333 professional and semiprofessional male ice hockey players: how are hip and groin symptoms, strength, and sporting function related? Orthop J Sports Med 7(2):2325967119825858 PubMedPubMedCentral Wörner T, Thorborg K, Eek F (2019) Five-second squeeze testing in 333 professional and semiprofessional male ice hockey players: how are hip and groin symptoms, strength, and sporting function related? Orthop J Sports Med 7(2):2325967119825858 PubMedPubMedCentral
16.
Zurück zum Zitat Hölmich P, Hölmich LR, Bjerg AM (2004) Clinical examination of athletes with groin pain: an intraobserver and interobserver reliability study. Br J Sports Med 38(4):446–451 CrossRef Hölmich P, Hölmich LR, Bjerg AM (2004) Clinical examination of athletes with groin pain: an intraobserver and interobserver reliability study. Br J Sports Med 38(4):446–451 CrossRef
17.
Zurück zum Zitat Lovell GA, Blanch PD, Barnes CJ (2012) EMG of the hip adductor muscles in six clinical examination tests. Phys Ther Sport 13(3):134–140 CrossRef Lovell GA, Blanch PD, Barnes CJ (2012) EMG of the hip adductor muscles in six clinical examination tests. Phys Ther Sport 13(3):134–140 CrossRef
18.
Zurück zum Zitat Garvey JF, Hazard H (2014) Sports hernia or groin disruption injury? Chronic athletic groin pain: a retrospective study of 100 patients with long-term follow-up. Hernia 18(6):815–823 CrossRef Garvey JF, Hazard H (2014) Sports hernia or groin disruption injury? Chronic athletic groin pain: a retrospective study of 100 patients with long-term follow-up. Hernia 18(6):815–823 CrossRef
19.
Zurück zum Zitat Holmich P, Dienst M (2006) Differential diagnosis of hip and groin pain. Symptoms and technique for physical examination. Orthopade 35(1):8–10–5 CrossRef Holmich P, Dienst M (2006) Differential diagnosis of hip and groin pain. Symptoms and technique for physical examination. Orthopade 35(1):8–10–5 CrossRef
20.
Zurück zum Zitat Hopkins JN, Brown W, Lee CA (2017) Sports hernia: definition, evaluation, and treatment. JBJS Rev 5(9):e6 CrossRef Hopkins JN, Brown W, Lee CA (2017) Sports hernia: definition, evaluation, and treatment. JBJS Rev 5(9):e6 CrossRef
21.
Zurück zum Zitat Bisciotti GN et al (2016) Groin pain syndrome Italian consensus conference on terminology, clinical evaluation and imaging assessment in groin pain in athlete. BMJ Open Sport Exerc Med 2(1):e142 CrossRef Bisciotti GN et al (2016) Groin pain syndrome Italian consensus conference on terminology, clinical evaluation and imaging assessment in groin pain in athlete. BMJ Open Sport Exerc Med 2(1):e142 CrossRef
22.
Zurück zum Zitat Thorborg K et al (2011) The Copenhagen hip and groin outcome score (HAGOS): development and validation according to the COSMIN checklist. Br J Sports Med 45(6):478–491 CrossRef Thorborg K et al (2011) The Copenhagen hip and groin outcome score (HAGOS): development and validation according to the COSMIN checklist. Br J Sports Med 45(6):478–491 CrossRef
23.
Zurück zum Zitat Hölmich P (2015) Groin injuries in athletes—development of clinical entities, treatment, and prevention. Dan Med J 62(12):B5184 PubMed Hölmich P (2015) Groin injuries in athletes—development of clinical entities, treatment, and prevention. Dan Med J 62(12):B5184 PubMed
24.
Zurück zum Zitat Mascarenhas VV et al (2020) The Lisbon agreement on femoroacetabular impingement imaging—part 1: overview. Eur Radiol 30(10):5281–5297 CrossRef Mascarenhas VV et al (2020) The Lisbon agreement on femoroacetabular impingement imaging—part 1: overview. Eur Radiol 30(10):5281–5297 CrossRef
25.
Zurück zum Zitat Gaudino F, Weber MA (2019) Osteitis pubis or symphysitis pubis. Radiologe 59(3):218–223 CrossRef Gaudino F, Weber MA (2019) Osteitis pubis or symphysitis pubis. Radiologe 59(3):218–223 CrossRef
26.
Zurück zum Zitat Murphy G et al (2013) “Superior cleft sign” as a marker of rectus abdominus/adductor longus tear in patients with suspected sportsman’s hernia. Skelet Radiol 42(6):819–825 CrossRef Murphy G et al (2013) “Superior cleft sign” as a marker of rectus abdominus/adductor longus tear in patients with suspected sportsman’s hernia. Skelet Radiol 42(6):819–825 CrossRef
27.
Zurück zum Zitat Gaudino F et al (2017) Osteitis pubis in professional football players: MRI findings and correlation with clinical outcome. Eur J Radiol 94:46–52 CrossRef Gaudino F et al (2017) Osteitis pubis in professional football players: MRI findings and correlation with clinical outcome. Eur J Radiol 94:46–52 CrossRef
28.
Zurück zum Zitat Branci S et al (2013) Radiological findings in symphyseal and adductor-related groin pain in athletes: a critical review of the literature. Br J Sports Med 47(10):611–619 CrossRef Branci S et al (2013) Radiological findings in symphyseal and adductor-related groin pain in athletes: a critical review of the literature. Br J Sports Med 47(10):611–619 CrossRef
29.
Zurück zum Zitat Holt MA et al (1995) Treatment of osteitis pubis in athletes. Results of corticosteroid injections. Am J Sports Med 23(5):601–606 CrossRef Holt MA et al (1995) Treatment of osteitis pubis in athletes. Results of corticosteroid injections. Am J Sports Med 23(5):601–606 CrossRef
30.
Zurück zum Zitat Thorborg K et al (2011) Hip adduction and abduction strength profiles in elite soccer players: implications for clinical evaluation of hip adductor muscle recovery after injury. Am J Sports Med 39(1):121–126 CrossRef Thorborg K et al (2011) Hip adduction and abduction strength profiles in elite soccer players: implications for clinical evaluation of hip adductor muscle recovery after injury. Am J Sports Med 39(1):121–126 CrossRef
31.
Zurück zum Zitat Harøy J et al (2019) The adductor strengthening programme prevents groin problems among male football players: a cluster-randomised controlled trial. Br J Sports Med 53(3):150–157 CrossRef Harøy J et al (2019) The adductor strengthening programme prevents groin problems among male football players: a cluster-randomised controlled trial. Br J Sports Med 53(3):150–157 CrossRef
32.
Zurück zum Zitat Gill TJ et al (2020) Surgical release of the adductor longus with or without sports hernia repair is a useful treatment for recalcitrant groin strains in the elite athlete. Orthop J Sports Med 8(1):2325967119896104 PubMedPubMedCentral Gill TJ et al (2020) Surgical release of the adductor longus with or without sports hernia repair is a useful treatment for recalcitrant groin strains in the elite athlete. Orthop J Sports Med 8(1):2325967119896104 PubMedPubMedCentral
33.
Zurück zum Zitat Charlton PC et al (2017) Exercise interventions for the prevention and treatment of groin pain and injury in athletes: a critical and systematic review. Sports Med 47(10):2011–2026 CrossRef Charlton PC et al (2017) Exercise interventions for the prevention and treatment of groin pain and injury in athletes: a critical and systematic review. Sports Med 47(10):2011–2026 CrossRef
Metadaten
Titel
Leistenschmerz beim Sportler
Was gibt es Neues?
verfasst von
Dr. med. Robert Lenz
Norman Holl
Christoph Lutter
Jens Krüger
Marc-André Weber
Thomas Tischer
Publikationsdatum
17.02.2022
Verlag
Springer Medizin
Erschienen in
Arthroskopie / Ausgabe 2/2022
Print ISSN: 0933-7946
Elektronische ISSN: 1434-3924
DOI
https://doi.org/10.1007/s00142-022-00516-8