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Athletic pubalgia treated with symphyseal cleft injection

Case contributed by Henry Knipe
Diagnosis certain

Presentation

High-level athlete with insidious post training groin pain.

Patient Data

Age: 25 years
Gender: Male

Pubic symphysis irregularity and capsular thickening. Fibrocartilage high signal. Mild bilateral pubic bone edema. Bilateral adductor origin complex enthesopathy with bilateral secondary cleft signs. Tenoperiosteal high signal along the left superior pubic ramus. 

Symphosography demonstrates bilateral secondary clefts. Subsequently, 1 mL Celestone and 0.5 mL local anesthetic were injected. 

Case Discussion

This is a case of athletic pubalgia in a high-level athlete with changes of osteitis pubis and adductor injury with a secondary cleft sign with a prior history of osteitis pubis around 5 years earlier, treated with long rest. The injection provoked his usual symptoms.

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