ARS syndrome is a disease affecting the tendons and ligaments that attach to the symphysis and pubic bone. Initially, it has an inflammatory, then degenerative-dystrophic character. It is caused by monotonous loads and repetitive microtraumas. It is found in athletes. It is manifested by pain in the lower abdomen and groin area, which increases when the hip is withdrawn. It is diagnosed on the basis of complaints, anamnesis, results of an objective examination, radiography, ultrasound and MRI data. Treatment includes exercise restriction, medications, physiotherapy, surgical interventions.
M70.8 Other soft tissue diseases associated with stress, overload and pressure
ARS syndrome is a fairly common disease among athletes. The abbreviation ARS stands for Adduktor-Rectus-Symphysis, contains the Latin names of the affected structures: adductor muscles of the thigh, rectus abdominis, pubic articulation. The syndrome has been known since 1958, the first description belongs to the Bulgarian doctor M. Bankov. Pathology is included in the group of myofascial pain syndromes of the pelvic area. It is most often diagnosed in football players. It can occur in people who are actively engaged in any kind of sports with an intense load on their legs. Significantly limits the capabilities of patients, may cause forced withdrawal from big-time sports.
Reasons of ARS syndrome
The main reason for the development of ARS syndrome is the discrepancy between the volume of physical exertion and the body’s ability to self-repair, especially against the background of instability of hard and soft tissue structures of the pelvis, lower extremity. Pathology is provoked by monotonous asymmetric loads on the hip, lower abdomen and groin area (for example, with forced reduction of the lower limb at the time of hitting the ball). The situation is aggravated by an ill-conceived training regime and a premature return to sports activities after an injury.
When the tendons and ligaments are overloaded, micro-tears occur in the areas of greatest tissue tension. In response to damage, local areas of edema and areas of inflammation are formed. The resistance of the tendon to stress decreases, blood circulation conditions in the affected area deteriorate. The above leads to the appearance of an increasing number of micro-fractures, the formation of micro-scars and areas of fatty degeneration.
Degenerative-dystrophic joins the inflammatory process. Enthesopathy develops. Tendinitis and tendovaginitis of the tendons of the abdominal and thigh muscles are formed in combination with a similar process in the area of ligaments and tendons of the symphysis. The result is a decrease in the functional capabilities of a patient with ARS syndrome, the occurrence of pain.
Symptoms of ARS syndrome
ARS syndrome is detected in young people who are actively involved in sports, usually in professional athletes. Patients complain of pain in the groin area, radiating along the affected muscles. The intensity of the pain syndrome can vary from mild or moderate to severe, significantly limiting the activity of the patient. There is a connection of pain with certain physical activities. Palpation determines local soreness in the tendon projection. When carrying out functional tests (bringing the hip with resistance, removing the hip, straining the abdominal muscles), the pain syndrome increases.
With a long-existing ARS syndrome, due to severe degeneration of tendon tissue, the likelihood of major injuries (tears and tears) increases. In some cases, the long-term persistence of the symptoms of the disease entails a forced restriction of physical activity, non-participation in competitions and even the rejection of a sports career. Complications can also be caused by drug therapy of pathology – with frequent blockades using glucocorticosteroid drugs, it is possible to aggravate degenerative processes in the affected department.
A preliminary diagnosis is often made by a sports doctor. To make a final diagnosis, an orthopedic examination and hardware tests are required. ARS syndrome can be suspected by a characteristic anamnesis (intense monotonous asymmetric loads), complaints of groin pain, increasing with movements, positive results of functional tests. The following instrumental techniques are assigned for confirmation:
- X-ray examination. With a prolonged course of ARS syndrome, the presence of degenerative-dystrophic changes in the area of articulation of the pubic bones is detected on pelvic radiographs. Similar lesions of the sacroiliac joints are possible.
- Ultrasound of the pubic articulation. During sonography, the condition of cartilage and bone structures, upper thigh muscles, areas of attachment of their tendons (enteses) is assessed. According to the results of the procedure, the expansion of the symphysis, degeneration of tendon and muscle fibers, especially pronounced in the area adjacent to the bone, is determined.
- MRI of pelvic bones. Scanning allows you to visualize inflammation and degeneration in the entheses and adjacent parts of the tendons, as well as in the symphysis and sacroiliac joints.
Treatment of ARS syndrome
Treatment can be carried out on an outpatient basis or in the conditions of the Department of traumatology and orthopedics. An important condition for successful therapy is the exclusion of intense physical exertion. Patients with ARS syndrome are recommended to temporarily stop training. In the early stages, drug therapy and physiotherapy are used. General NSAIDs are prescribed, corticosteroids are injected into the affected area. The following physiotherapy methods are used:
- laser therapy;
- magnetic therapy;
- Bernard ‘s currents;
- electrophoresis with painkillers;
- massage, physical therapy.
Kinesiotherapy is indicated for the area of the pubic joint and adjacent muscles. The most effective conservative method of treatment is shock wave therapy.
Surgical treatment of ARS syndrome
In case of ineffectiveness of conservative methods, frequent relapses, surgical intervention is recommended. During the operation with ARS syndrome, a partial dissection of the thigh and abdominal muscles involved in the pathological process is performed with their simultaneous plastic reconstruction. The patient is allowed to get up on the second day. In the postoperative period, analgesics and antibacterial agents are prescribed.
After 3 weeks, with satisfactory ultrasound data indicating sufficient recovery of the operated structures, rehabilitation begins, which includes physical therapy, electromyostimulation, hydrokinesotherapy. A month after surgical treatment of ARS syndrome, running without obstacles and accelerations is allowed. After a month and a half, the patient is allowed to train, a gradual increase in the load is recommended.
Prognosis and prevention
The prognosis of patients with ARS syndrome can be considered as conditionally favorable. The effectiveness of conservative therapy is low, sustained improvement occurs in 20-25%. The best results are noted after shock wave therapy. After surgical treatment, the pain syndrome disappears, patients return to sports as usual, but relapses are possible in the long term. Preventive measures include a well-thought-out training regime, a gradual increase in sports loads, and ensuring a sufficient recovery period after injuries.