Professor Rowena Johnson – Imaging of Groin and Hip Pain in Athletes – Injury Rehab Network

The first Injury Rehab Network event of October 2023 with BASRaT featured Professor Rowena Johnson, Consultant Musculoskeletal Radiologist. The online event took place on the evening of 5th October with 300 sports rehabilitation professionals in attendance.

Rowena’s presentation looked at the optimum radiological modalities for imaging groin and hip pain in athletes.

Prof Rowena Johnson, Consultant Musculoskeletal Radiologist (Fortius Clinic)

Professor Rowena Johnson is a Consultant Musculoskeletal Radiologist with expertise in diagnostic imaging and image-guided treatments of elite athletes, including diagnostic ultrasound and ultrasound-guided interventions. She works with numerous international athletes and clubs, including the Premier League, Championship football, Lawn Tennis Association, British Olympic team, British Athletics, British Triathlon, international rugby and cricket, and the Royal Ballet. She works at the Fortius Clinic London which is a FIFA-accredited medical centre of excellence. She is a full professor of Sports Medicine Imaging at the Carnegie School of Sport, Leeds Beckett University which is the largest provider of sport in UK higher education. She is also a visiting professor at the University of Dartmouth, USA.

She is the Chair and Clinical Lead of the Royal College of Radiologists Education, overseeing the clinical radiology annual congress, national and international meetings, and the online education platform. She has also been appointed to the Royal College of Radiologists Faculty Board, Scientific Council of the International Society of Clinical Densitometry and Vice-Chair of their UK/Ireland panel. She has led iRefer, the Royal College of Radiologists’ flagship publication. This is an internationally recognised framework for patients to have the optimum investigation and intervention for all radiological specialities, including musculoskeletal, and ensure high standards of care.

Imaging of groin and hip pain in athletes

Rowena’s presentation looked at the optimum radiological modalities for imaging groin and hip pain in athletes. She explained the anatomy and imaging of the inguinal canal and the use of selective nerve blocks to diagnose the cause of pain. Professor Johnson also discussed the anatomy and classification of Pyramidalis- Anterior Pubic Ligament- Adductor Longus Complex (PLAC) injuries, alongside correlation with the imaging and surgical findings. Furthermore, Rowena discussed radiological findings in hip pain in athletes, including advanced imaging techniques as well as common incidental findings related to sports.

Rowena’s presentation considered the following four areas with differential diagnosis for:

1. Hip
2. Inguinal Canal
3. Adductors/ PLAC
4. Pubic Bones

Take Home Messages

Professor Johnson concluded the presentation with the following advice and take-home messages

Hip

• High prevalence of cam – and pincer-type morphology and labral tears in asymptomatic cases
• In athletes with hip pain, periarticular structures should be imaged as potential causes of pain, including adductor, iliopsoas, and inguinal canal
• Treat the person/ player, not the picture

Inguinal

• The posterior wall is not the answer to all inguinal pain in athletes
• Address all possible components of inguinal pain
• Workup with ultrasound and selective nerve blocks is essential

Adductors

• The answer to understanding groin pain in athletes lies in the ANATOMY
• Use the appropriate imaging
• A dedicated MRI groin study protocol with small-field imaging is essential for consistency in image interpretation
• PLAC concept can help with MRI interpretation and surgical planning

Pubic Bones

• Treat the player, not the picture
• T1 pseudo CT- pubic apophyses
• Consider pubic symphysis osteopenia in chronic cases

Q&A

Rowena kindly answered questions put forward by the practitioners who attended the session.

Follow Professor Rowena Johnson

@RowenaSports

2023 Injury Rehab Network events

Find out about and register your interest for all the Injury Rehab Network events with BASRaT planned for 2023