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<v ->Dr. P here.

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23 year old professional football player

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with sports hernia syndrome.

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Discomfort in the groin area,

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inability to develop a leg drive,

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discomfort with hip flexion on the right.

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Let's take a look at his coronal

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simple T1 fat-weighted images.

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He's got a sloped looking pubic symphysis.

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I mean this kid is 23 years old.

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Look at that pubis

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with erosions, spurs, irregularity.

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Nice superior pubic ligament.

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Look at the arcuate ligament.

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It's very distorted and irregular looking.

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You don't see a nice, clean undersurface

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arcuate ligament at all.

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So the arcuate ligament is degenerated.

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At that alone will produce pain,

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but not necessarily weakness or loss of function.

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So where after,

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delamination of the structures that attach here:

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the rectus abdominis, the adductor longus,

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or the merger of the two,

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the so-called pre-pubic plate.

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So this would be high, mid and low areas

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searching for sports hernia syndrome.

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We'll also look along the lateral border of the rectus

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in the region of the linea semilunaris,

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right adjacent to the Inguinal Canal and ligament.

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So let's scroll up and down.

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The T2-weighted image gives us so much comfort,

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falsely

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because in chronic scenarios,

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fibrous tissue? Dark.

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Blood? Dark.

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Tendons? Dark. You'll miss it.

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You need to have a proton density,

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frequency selective, fat-suppression, spur sparrow special

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or at low field, a stir.

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We scroll up and down.

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The rectus abdomini. The two components are symmetric.

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Let's go high, then we'll go low

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and everything looks peachy.

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Or maybe not.

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If your eye drifted over to this side,

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to the proton density, more serious, fat-suppression image,

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there is clear a symmetry between the two.

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In other words,

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there is a subtle hyperintensity in the pre-pubic plate

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on the right.

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I'm going to draw over it right now

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and then I'm going to take it away so you can see it.

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There it is.

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Now I'm going to magnify it so you can see it.

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The so-called cleft sign,

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one of the types of cleft sign

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in sports hernia syndrome

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in a patient with underlying Athletic Pubalgia

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or osteitis pubis.

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Let's move on, Dr. PL.