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  • Understanding Common Athletic Injury is Key to Prevention

    January 01, 2013

    An improved understanding of potential athletic pubalgia injuries could lead to better training techniques and regimens to reduce occurrences.

    An improved understanding of potential athletic pubalgia injuries—a clinical
    spectrum of disease associated with lower abdominal and groin injuries affecting both high performance and recreational athletes—could lead to better training techniques and regimens to reduce occurrences, according to findings presented at RSNA 2012.

    Daily Bulletin coverage of RSNA 2012 is available at RSNA.org/bulletin.

    Arvin Kheterpal, M.D., a third-year resident at Thomas Jefferson University Hospital in Philadelphia, conducted a retrospective study of 70 American football players treated at his facility. Players averaged about 22 years old and ranged in playing level from professional to college to high school and some recreational.

    “Nobody had actually looked to see whether specific lesions and injury patterns are correlated with any specific activity,” Dr. Kheterpal said. “We know there are distinct patterns of injury that we see on MR, but we don’t know if there are any reproducible patterns in football, in particular. That’s why we wanted to take a look at it.”

    Dr. Kheterpal learned that 41.4 percent of the pubalgia cases occurred in the midline section, and 44 percent had unilateral aponeurosis injury, leading him to conclude that pubalgia could be prevented with focused core-strengthening training.

    Pubalgia is often referred to as “sports hernia” by media and has become well-known by people who play or follow football, as it occurs regularly to athletes throughout a season. A Google search on the term “sports hernia,” included in Dr. Kheterpal’s presentation, produced more than 1.7 million results. Dr. Kheterpal hastened to add, however, that the term is technically incorrect—rarely does an actual hernia occur.

    Pubalgia recently received attention when a National Football League player suffered a groin injury and was forced to leave a nationally televised game on Thanksgiving Day. The player, a linebacker for the Houston Texans, was expected to miss three to four weeks of playing time.

    “Athletic pubalgia can be very debilitating,” Dr. Kheterpal said. “It can lead to loss of playing time or prematurely cut short careers. We’re pretty excited about what we found, but there’s actually quite a bit of work that needs to be done. For us this is only the tip of the iceberg.”

    Dr. Kheterpal said his group has anecdotally noted similar distinct injury patterns in other sports and within football. For example, a linebacker often generates lateral motion, as the position dictates, and is more likely to suffer a unilateral injury. A quarterback, however, doesn’t generate as much lateral motion, and would be more likely to receive a midline injury. He added the same could be true for other sports and specific positions as well, including baseball hitters and pitchers, hockey goalies and defensemen, soccer forwards and lacrosse attackmen.

    “We have a feeling that depending on the position you play and sport you play, you may be predisposed to a different injury,” Dr. Kheterpal said.

    Prostate Cancer Outcomes Worse for Arab Americans

    Ovidiu Marina, M.D.

    Significant differences in mortality and incidence exist among ethnicities when it comes to prostate cancer, and it appears that Arab or Chaldean (Iraqi Catholic) Americans in Southeastern Michigan have worse outcomes for the disease than other ethnic groups, said Ovidiu Marina, M.D., during an RSNA 2012 session.

    Daily Bulletin coverage of RSNA 2012 is available at RSNA.org/bulletin.

    There is an imperative to this kind of research in areas like metropolitan Detroit, which is, according to Dr. Marina, home to 320,000 Arab and Chaldean Americans (the largest concentration of Arab Americans in the U.S.) as well as Dr. Marina’s institution, William Beaumont Hospital.

    According to co-investigator Mohamad Dabjan, M.D., also of Beaumont Hospital, while there have been studies on outcomes of prostate cancer treatment for African Americans and Hispanic Americans, “there has been no large study of Arab or Chaldean Americans, and we need to see if there is any difference in outcomes.”

    This study followed 2,672 patients with prostate cancer who were treated with definitive radiation therapy (brachytherapy, external beam therapy, and brachytherapy boost) between 1991 and 2011. Patients were categorized by ethnicity into European Americans (2,248 patients), African Americans (287 patients) and Arab and Chaldean Americans (137 patients). Researchers then compared clinical outcomes by ethnicity according to biochemical control, disease-free survival, cause-specific survival and overall survival

    Researchers found no difference in clinical outcomes by ethnicity for low-risk patients. But, while there were no differences in clinical outcomes for intermediate-risk patients in biomedical control and overall survival, Arab and Chaldean Americans had reduced cause-specific survival rates and a trend towards reduced disease-free survival. Finally, in high-risk patients, Arab and Chaldean Americans had significantly reduced rates of disease-free survival, according to researchers.

    “Outcomes were worse for Arab and Chaldean Americans than for white and African Americans, but we don’t know why that is,” said Dr. Dabjan although Dr. Marina suggested there could be several reasons. He pointed out, for example, that the African American community in the area in which the study took place is more affluent than the Arab and Chaldean American community.

    In addition, said Dr. Marina, there could be socioeconomic issues associated with the differences in outcomes. “This is largely an immigrant population,” Dr. Marina said. “So in ways they still do have barriers to care due to difficulty with language, sometimes cost and (with access) to transportation,” he said. In addition, Arab and Chaldean Americans have significantly lower follow up rates than their white and African American counterparts.

    According to Dr. Dabjan, more investigation will be needed to assess the impact of diet, socioeconomic and cultural factors on outcomes, but it is clear that many Arab and Chaldean Americans “don’t screen well” for prostate cancer. “We need to educate the population about the benefits of early screening and detection,” he said.

    Web Extras

    Dabjan, Marina

    VideoHear Mohamad Badi Dabjan M.D., (left) and Ovidiu Marina, M.D., (right) discuss their RSNA 2012 research, “Comparison of Clinical Outcomes Following Definitive Prostate Radiotherapy by Ethnicity,” including:

    • Why there is limited data for prostate cancer based on ethnicity, here 
    • The impetus for their research, here 
    • The methodology of their research, here 
    • Results in terms of outcomes for prostate cancer, here 
    • Clinical relevance of their findings, here 
    Arvin Kheterpal, M.D. with background
    Arvin Kheterpal, M.D.
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