Thank you for your interesting letter.

Lateral epicondylitis is a common condition and your analogy is an interesting one. The current consensus is that lateral epicondylitis is initiated as a microtear, most often within the origin of the extensor carpi radialis brevis(1). The clinical features include pain at the ECRB origin/enthesis, pain on passive stretching and resisted movement. It may be that future work on lateral epicondylitis and the enthesis organ will indeed add weight to your hypothesis.

Our experience is that adductor enthesopathy is common in recreational athletes; however, to date, there have been no studies that investigate this entity. In lieu of such evidence, we sugest that the general principles of management we outlined in our paper can be applied to recreational athletes(2). We are currently studying addductor enthesopathy in recreational athletes and hope to report our results when the study is completed.

References:

1. Jobe FW, Ciccotti MG. Lateral and medial epicondylitis of the elbow. J Am Acad Orthop Surg 1994;2:1-8.

2. Schilders E, Bismil Q, Robinson P, O'Connor PJ, Gibbon WW, Talbot JC. Adductor-related groin pain in competitive athletes. Role of adductor enthesis, magnetic resonance imaging, and entheseal pubic cleft injections. J Bone Joint Surg Am. 2007 Oct;89(10):2173-8.

To The Editor:

We would like to commend the authors for presenting an excellent overview of the general problem of athletic groin pain and the particular problem of adductor enthesopathy in competitive athletes. We would like to pose the following questions to the authors:

The entity of adductor enthesopathy seems to be analogous to lateral epicondylitis in the elbow- do they think this is a reasonable analogy?

2. Since reading their paper(1), we have seen some recreational athletes who appear to have adductor enthesopathy. Does this problem occur in recreational athletes and if so, how can we apply the results of the study to them?

The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

References:

1. Schilders E, Bismil Q, Robinson P, O'Conor PJ, Gibbon WW, Talbot JC. Adductor-related groin pain in competitive athletes. Role of adductor enthesis, magnetic resonance imaging, and entheseal pubic cleft injections. J Bone Joint Surg Am. 2007;89:2173-2178.