Athletic pubis

Osteitis pubis is a common source of groin pain in athletes participating in sports requiring kicking, twisting, and pivoting movements. Athletes will present with progressive pain or discomfort in the pubic area or groin. There is usually point tenderness over the pubic symphysis and pain localizing to the adductor or rectus abdominis tendons. Conservative management often includes activity modification, oral medications, progressive rehabilitation, therapeutic ultrasound, steroid injections, and prolotherapy...

Core muscle injury is a common but difficult problem to treat. Although it can affect all individuals, it is most commonly seen in male athletes in cutting, twisting, pivoting, and explosive sports. Owing to the high association of femoroacetabular impingement, we believe these individuals are best treated with a multidisciplinary approach involving both orthopedic and general surgeons. Conservative treatment should be the first step in management. When conservative means are unsuccessful, operative intervention to correct all the pathologic issues around the pubis can have extremely high success rates...

Often referred to as a "sports hernia" or "core muscle injury," athletic pubalgia is a common yet poorly defined athletic injury. It is characterized by abdominal and groin pain likely from weakening or tearing of the abdominal wall without evidence of a true hernia. Symptoms can appear acutely or insidiously, primarily as groin and lower abdominal pain that can radiate toward the perineum and proximal adductors. Pain is exacerbated by athletic activity such as kicking, cutting, and sprinting. The pubis acts as a pivot point between the abdominal musculature and lower-extremity adductors, and therefore, pain with palpation over the symphysis or its surrounding structures is typical in athletic pubalgia...

BACKGROUND: Open surgical treatment of the pubic region and adductor related pathologies require an exact knowledge of the arterial blood supply of the symphysis pubis that seems furthermore important to explain the hematogenous occurrence of symphysitis. Pubic bone marrow oedema (PBME) is a frequent occurring magnetic resonance imaging finding in groin pain. However, even asymptomatic athletes present PBME and a correlation to the physical activity or higher blood flow was suggested...

OBJECTIVE: To determine the prevalence of athletic pubalgia imaging findings on MRI in patients with femoroacetabular impingement and assess for correlative risk factors. MATERIALS AND METHODS: A retrospective search identified 156 hips with femoroacetabular impingement and a control group of 113 without femoroacetabular impingement that had an MRI performed between January 1, 2015, and January 1, 2018. Two fellowship-trained musculoskeletal radiologists reviewed studies for the presence of acute osteitis pubis, chronic osteitis pubis, adductor tendinosis, and tendon tear; rectus abdominis tendinosis and tendon tear; and aponeurotic plate tear...

Athletic pubalgia presents with groin and/or pubic pain mainly in athletes. The purpose of this review is to analyze, by evaluating current literature, the clinical examination and differential diagnosis of athletic pubalgia, in an effort to better understand this clinical entity. Diagnosis is challenging due to the anatomical complexity of the groin area, the biomechanics of the pubic Romasymphysis region and the large number of potential sources of groin pain. Clinical examination and medical history are of utmost importance...

AIM: To confirm that pubic apophysitis is common in Australian Rules footballers with groin pain. MATERIALS AND METHODS: Thirteen male Australian Football League (AFL) players with groin pain were assessed with volumetric interpolated breath-hold examination (VIBE) MRI over the 2017, 2018, and 2019 AFL seasons. Images were reviewed for pubic maturation, the presence of pubic apophysitis, and associated bone pathology and correlated with side of groin pain. RESULTS: Pubic apophysitis was seen in 92% of AFL players with groin pain...

BACKGROUND: Osteitis pubis (OP) is a common source of groin and extra-articular hip pain and is associated with intra-articular hip pathology. In this study, we aimed to determine the prevalence of osteitis pubis on magnetic resonance imaging (MRI) in non-athletic patients with cam-type femoroacetabular impingement (FAI). METHODS: This retrospective cross-sectional study included 178 subjects: 90 patients with cam-type FAI diagnosed by MRI and 88 subjects used as a control group...

A case report is presented that gives new insight into a very rare cause of athletic pubalgia. Up till now, no case has been published in literature about the relevance of an arcuate pubic ligament (APL) injury in athletic pubalgia. The APL or inferior pubic ligament is a thick triangular arch of ligamentous fibers connecting the 2 pubic bones below. The main function of the APL is to stabilize the symphysis pubis. The rupture of this ligament can lead to groin pain due to lack of stabilization of the symphysis pubis...

Core muscle injuries are being diagnosed with increasing frequency in athletes. Knowledge of the anatomy is key to understanding the pathology. Notably, the origin on the pubis of the majority of adductor long muscles is via direct insertion of the muscle to the bone and not via a tendon, thus making direct repair difficult.

Objective  To compare the accuracy of ultrasound (US) with that of magnetic resonance imaging (MRI) in the detection of aponeurosis lesions of the rectus abdominis/adductor longus muscles, to study the characteristics of the athletes and imaging findings associated with pubalgia, and to demonstrate the importance of each method in evaluating this condition. Materials and methods  The present study was conducted from 2011 to 2016 with 39 professional soccer players: 15 with pubalgia and 24 without pubalgia...

This review summarises aetiology, diagnostic approach, and treatment of longstanding groin pain, which can be divided in adductor-related, pubis-related, iliopsoas-related, and inguinal-related pain. Among the diagnoses included in the inguinal-related entity is the so-called sports hernia. However, the terminology is a misnomer since sports hernia is characterised by not being a hernia. Both athletes and non-athletes are affected, and the condition may cause long sick leaves. The treatment is primarily exercise treatment...

Osteomyelitis pubis is a rare orthopedic infection, accounting for less than 1-2 percent of all hematogenous osteomyelitis. Osteomyelitis pubis generally affects children, elderly patients who have undergone genitourinary procedures, and parenteral drug users. Interestingly, cases of acute osteomyelitis pubis have also been documented in previously young, healthy athletes. The diagnosis is often difficult to differentiate from osteitis pubis, which is a self-limiting, painful inflammatory condition affecting the symphysis pubis...

BACKGROUND: There is a dearth of knowledge regarding the correlation between femoroacetabular impingement (FAI) and osteitis pubis (OP) among symptomatic soccer players. PURPOSE: To elucidate whether arthroscopic FAI correction is effective for young competitive soccer players with FAI combined with OP or perisymphyseal pubic bone marrow edema (BME). STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 577 consecutive patients who underwent arthroscopic FAI correction were retrospectively reviewed with a minimum 2-year follow-up...

Osteitis pubis is a common cause of chronic groin pain, especially in athletes. Although a precise etiology is not defined, it seems to be related to muscular imbalance and pelvic instability. Diagnosis is based on detailed history, clinical evaluation, and imaging, which are crucial for a correct diagnosis and proper management. Many different therapeutic approaches have been proposed for osteitis pubis; conservative treatment represents the first-line approach and provides good results in most patients, especially if based on an individualized multimodal rehabilitative management...

CLINICAL/METHODICAL ISSUE: Osteitis pubis is one of the most common causes of chronic groin pain in many professional athletes. Symphysitis pubis with instability of the joint due to softening of the joint capsule and muscular imbalance of the corresponding muscles increases the instability of the sympyseal region, thus, resulting in a vicious cycle. STANDARD RADIOLOGICAL METHODS: Magnetic resonance imaging (MRI). METHODICAL INNOVATIONS: Optimized MRI sequence protocol with oblique (axial oblique) layers parallel to the linea arcuata of iliac bone together with large image field for depiction of the entire pelvis and high-resolution sequences focused on the symphysis pubis...

There is a continuum between Athletic (Sports) Hernia, Osteitis Pubis, and Osteomyelitis Pubis. The pubis is the site of attachment of many "core" muscles. A lay term used to describe a hernia is "rupture". Athletic hernia denotes a tear. Chronic musculotendinous strain may cause inflammation (osteitis pubis). An inflammatory focus may become a nidus for infection (osteomyelitis pubis). The symptoms caused by these three entities blur one with the other and with those characterizing acute appendicitis...

A 23-year-old African native male patient presented with fever, lumbalgia and dysuria after returning from a trip to Togo. His physical examination revealed pain over the pubic symphysis and rectal tenderness on digital exam. The C-reactive protein (CRP) level was elevated along with positive blood and urinary cultures for methicillin-resistant Staphylococcus aureus . An magnetic resonance imaging that has been performed to rule out arthritis/osteomyelitis in the pubis revealed edema of the symphysis. An 18 F-FDG positron emission tomography/computed tomography supported the diagnosis of prostate infection and showed a focal uptake of the pubic symphysis, with diffuse hyper-metabolism of the insertions of the rectus abdominis and longus adductor muscles, corresponding to athletic pubalgia...

Groin pain is a common problem in athletes. The diagnosis can be difficult because of the complexity of the groin anatomy, the numerous clinical entities presenting with similar symptoms, the concurrence of those entities and the confusing terminology. Thus, a dilemma in diagnosis may arise leading to long-standing symptoms, disabling groin pain, mismanagement and therefore to poor treatment. Hereby, we present such a case of a recreational athlete complaining for excruciate pubic pain after being misdiagnosed and subsequently mistreated affecting her quality of life...

BACKGROUND: Osteitis pubis is a common cause of chronic groin pain. Due to high clinical uncertainty and varying etiopathology, the diagnosis is often delayed. Especially athletes suffer from this disease, but patients with orthopaedic, traumatological, neurological, urological, gynaecological, and rheumatic complaints can also be affected. Osteitis pubis can be treated by conservative as well as surgical techniques. MATERIAL AND METHODS: Systematic literature research, descriptive presentation of the studies, and interpretation of evidence-based medicine results...