Athletic pubalgia is a clinical syndrome of chronic lower pelvic and groin pain, usually encountered in athletes. It is either a musculotendinous 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 was first described as Gilmore’s groin and has been commonly known as sportsman's hernia or sports hernia, although the latter two are a misnomer since an actual hernia does not occur. Groin disruption injury is another term that has fallen out of favor. More recently (c.2020) core muscle injury or groin pain in athletes 7 have been preferred terms by some to refer to athletic pubalgia.
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:
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