Athletic pubalgia

Athletic pubalgia refers to pain around the pubic symphysis and can have different causes, including what has become known as sports hernia or sportman's hernia and osteitis pubis.

Athletic pubalgia is a clinical syndrome of chronic lower pelvic and groin pain, usually encountered in athletes. It is either a musculo-tendinous or osseous injury that involves the insertion of abdominal muscles on the pubis and the upper aponeurotic insertion of the adductor muscles. Although it can occur following an acute injury, it is most often the result of repeated microtrauma.

Athletic pubalgia is a diagnosis of exclusion. Other more important causes of groin pain must first be ruled out. The symptoms are usually very non-specific and include:

  • tenderness on palpation of the medial inguinal floor
  • tenderness on palpation over the pubic ramus
  • exacerbated pain with resisted hip adduction

Sportman's hernia can only be diagnosed on MRI and findings are usually very subtle. A specific protocol for this pathology must be performed to result in a reliable diagnosis.

The most specific finding is a hyperintense T2WI signal involving the anteroinferior aspect of the pubic symphysis. Other findings include:

  • osteitis pubis, which can also be appreciated on CT
  • tenoperiosteal disruption of the aponeurosis or frank tear
  • marrow edema at the pubic tubercle

Causes of groin pain in athletes are divided into three categories:

  1. defined clinical entities for groin pain:
    • adductor-related 
    • pubic-related
    • iliopsoas-related
    • inguinal-related
  2. hip related causes of groin pain 
  3. other causes of groin pain in athletes, such as:

The name "sports hernia" is a misnomer, since an actual hernia does not occur. However, it is commonly misdiagnosed as an inguinal hernia and the surgical approach is similar to hernia repair.

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Article information

rID: 19767
Section: Gamuts
Tag: cases
Synonyms or Alternate Spellings:
  • Sports hernia
  • Sportsman hernia
  • Hockey hernia
  • Athletic pubalgias
  • Sports herniation

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Cases and figures

  • Case 1: Sportman's hernia
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  • Case 2: osteitis pubis
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  • Case 3: osteitis pubis
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  • Case 4: adductor longus tear
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