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Athletic Pubalgia
Kirkland W. Davis, MD, FACR; Adam C. Zoga, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Sportsman's hernia, sports hernia, core injury, rectus abdominis/adductor aponeurosis injury, aponeurosis lesion
              • Athletic pubalgia: Clinical synonym but not correctly used as imaging term
            • Definitions

              • Clinical syndrome of midline groin pain related to athletic activity
              • Pubic bodies serve as attachments for rectus abdominis, adductors (esp. adductor longus), inguinal ligament, multiple pubic ligaments
              • Rectus abdominis fibers continue over pubis and into adductor longus as rectus-adductor aponeurosis
              • Midline pubic plate is anterior midline tissue with contributions from aponeuroses, anterior pubic ligament, periosteum of pubic bones
              • Aponeurosis (lateral portion) or midline pubic plate can be detached from pubis, strained, frankly torn, or any combination
                • Detachments often occur with strain; frank tears less common but still prevalent
              • Sports hernia debated as actual entity: Some state deficiency in posterior inguinal wall causes pain, benefits from surgical repair; concept strongly doubted as typical primary culprit by others
                • Not true inguinal or femoral hernia
              • Terminology continues to evolve

            IMAGING

            • General Features

              • Imaging Recommendations

                • Radiographic Findings

                  • Fluoroscopic Findings

                    • CT Findings

                      • MR Findings

                        • Ultrasonographic Findings

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Staging, Grading, & Classification

                                • Gross Pathologic & Surgical Features

                                  • Microscopic Features

                                    CLINICAL ISSUES

                                    • Presentation

                                      • Demographics

                                        • Natural History & Prognosis

                                          • Treatment

                                            DIAGNOSTIC CHECKLIST

                                            • Consider

                                              • Image Interpretation Pearls

                                                • Reporting Tips

                                                  Selected References

                                                  1. Coker DJ et al: The role of magnetic resonance imaging in athletic pubalgia and core muscle injury. Top Magn Reson Imaging. 24(4):183-91, 2015
                                                  2. Hopp SJ et al: Osteitis pubis and adductor tendinopathy in athletes: a novel arthroscopic pubic symphysis curettage and adductor reattachment. Arch Orthop Trauma Surg. 133(7):1003-9, 2013
                                                  3. Khan W et al: Magnetic resonance imaging of athletic pubalgia and the sports hernia: current understanding and practice. Magn Reson Imaging Clin N Am. 21(1):97-110, 2013
                                                  4. Murphy G et al: "Superior cleft sign" as a marker of rectus abdominus/adductor longus tear in patients with suspected sportsman's hernia. Skeletal Radiol. 42(6):819-25, 2013
                                                  5. Palisch A et al: Imaging of athletic pubalgia and core muscle injuries: clinical and therapeutic correlations. Clin Sports Med. 32(3):427-47, 2013
                                                  6. Weber MA et al: Groin Pain in Athletes. Rofo. ePub, 2013
                                                  7. Balconi G: US in pubalgia. J Ultrasound. 14(3):157-66, 2011
                                                  8. Meyers WC et al: Experience with "sports hernia" spanning two decades. Ann Surg. 248(4):656-65, 2008
                                                  9. Omar IM et al: Athletic pubalgia and "sports hernia": optimal MR imaging technique and findings. Radiographics. 28(5):1415-38, 2008
                                                  10. Shortt CP et al: Anatomy, pathology, and MRI findings in the sports hernia. Semin Musculoskelet Radiol. 12(1):54-61, 2008
                                                  11. Zajick DC et al: Spectrum of MRI findings in clinical athletic pubalgia. Semin Musculoskelet Radiol. 12(1):3-12, 2008
                                                  12. Zoga AC et al: Athletic pubalgia and the "sports hernia": MR imaging findings. Radiology. 247(3):797-807, 2008
                                                  13. Cunningham PM et al: Patterns of bone and soft-tissue injury at the symphysis pubis in soccer players: observations at MRI. AJR Am J Roentgenol. 188(3):W291-6, 2007
                                                  14. Robinson P et al: Cadaveric and MRI study of the musculotendinous contributions to the capsule of the symphysis pubis. AJR Am J Roentgenol. 188(5):W440-5, 2007
                                                  15. Brennan D et al: Secondary cleft sign as a marker of injury in athletes with groin pain: MR image appearance and interpretation. Radiology. 235(1):162-7, 2005
                                                  16. Robinson P et al: Adductor-related groin pain in athletes: correlation of MR imaging with clinical findings. Skeletal Radiol. 33(8):451-7, 2004
                                                  17. Meyers WC et al: Management of severe lower abdominal or inguinal pain in high-performance athletes. PAIN (Performing Athletes with Abdominal or Inguinal Neuromuscular Pain Study Group). Am J Sports Med. 28(1):2-8, 2000
                                                  Related Anatomy
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                                                  Related Differential Diagnoses
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                                                  References
                                                  Tables

                                                  Tables

                                                  KEY FACTS

                                                  • Terminology

                                                    • Imaging

                                                      • Pathology

                                                        • Clinical Issues

                                                          • Diagnostic Checklist

                                                            TERMINOLOGY

                                                            • Synonyms

                                                              • Sportsman's hernia, sports hernia, core injury, rectus abdominis/adductor aponeurosis injury, aponeurosis lesion
                                                              • Athletic pubalgia: Clinical synonym but not correctly used as imaging term
                                                            • Definitions

                                                              • Clinical syndrome of midline groin pain related to athletic activity
                                                              • Pubic bodies serve as attachments for rectus abdominis, adductors (esp. adductor longus), inguinal ligament, multiple pubic ligaments
                                                              • Rectus abdominis fibers continue over pubis and into adductor longus as rectus-adductor aponeurosis
                                                              • Midline pubic plate is anterior midline tissue with contributions from aponeuroses, anterior pubic ligament, periosteum of pubic bones
                                                              • Aponeurosis (lateral portion) or midline pubic plate can be detached from pubis, strained, frankly torn, or any combination
                                                                • Detachments often occur with strain; frank tears less common but still prevalent
                                                              • Sports hernia debated as actual entity: Some state deficiency in posterior inguinal wall causes pain, benefits from surgical repair; concept strongly doubted as typical primary culprit by others
                                                                • Not true inguinal or femoral hernia
                                                              • Terminology continues to evolve

                                                            IMAGING

                                                            • General Features

                                                              • Imaging Recommendations

                                                                • Radiographic Findings

                                                                  • Fluoroscopic Findings

                                                                    • CT Findings

                                                                      • MR Findings

                                                                        • Ultrasonographic Findings

                                                                          DIFFERENTIAL DIAGNOSIS

                                                                            PATHOLOGY

                                                                            • General Features

                                                                              • Staging, Grading, & Classification

                                                                                • Gross Pathologic & Surgical Features

                                                                                  • Microscopic Features

                                                                                    CLINICAL ISSUES

                                                                                    • Presentation

                                                                                      • Demographics

                                                                                        • Natural History & Prognosis

                                                                                          • Treatment

                                                                                            DIAGNOSTIC CHECKLIST

                                                                                            • Consider

                                                                                              • Image Interpretation Pearls

                                                                                                • Reporting Tips

                                                                                                  Selected References

                                                                                                  1. Coker DJ et al: The role of magnetic resonance imaging in athletic pubalgia and core muscle injury. Top Magn Reson Imaging. 24(4):183-91, 2015
                                                                                                  2. Hopp SJ et al: Osteitis pubis and adductor tendinopathy in athletes: a novel arthroscopic pubic symphysis curettage and adductor reattachment. Arch Orthop Trauma Surg. 133(7):1003-9, 2013
                                                                                                  3. Khan W et al: Magnetic resonance imaging of athletic pubalgia and the sports hernia: current understanding and practice. Magn Reson Imaging Clin N Am. 21(1):97-110, 2013
                                                                                                  4. Murphy G et al: "Superior cleft sign" as a marker of rectus abdominus/adductor longus tear in patients with suspected sportsman's hernia. Skeletal Radiol. 42(6):819-25, 2013
                                                                                                  5. Palisch A et al: Imaging of athletic pubalgia and core muscle injuries: clinical and therapeutic correlations. Clin Sports Med. 32(3):427-47, 2013
                                                                                                  6. Weber MA et al: Groin Pain in Athletes. Rofo. ePub, 2013
                                                                                                  7. Balconi G: US in pubalgia. J Ultrasound. 14(3):157-66, 2011
                                                                                                  8. Meyers WC et al: Experience with "sports hernia" spanning two decades. Ann Surg. 248(4):656-65, 2008
                                                                                                  9. Omar IM et al: Athletic pubalgia and "sports hernia": optimal MR imaging technique and findings. Radiographics. 28(5):1415-38, 2008
                                                                                                  10. Shortt CP et al: Anatomy, pathology, and MRI findings in the sports hernia. Semin Musculoskelet Radiol. 12(1):54-61, 2008
                                                                                                  11. Zajick DC et al: Spectrum of MRI findings in clinical athletic pubalgia. Semin Musculoskelet Radiol. 12(1):3-12, 2008
                                                                                                  12. Zoga AC et al: Athletic pubalgia and the "sports hernia": MR imaging findings. Radiology. 247(3):797-807, 2008
                                                                                                  13. Cunningham PM et al: Patterns of bone and soft-tissue injury at the symphysis pubis in soccer players: observations at MRI. AJR Am J Roentgenol. 188(3):W291-6, 2007
                                                                                                  14. Robinson P et al: Cadaveric and MRI study of the musculotendinous contributions to the capsule of the symphysis pubis. AJR Am J Roentgenol. 188(5):W440-5, 2007
                                                                                                  15. Brennan D et al: Secondary cleft sign as a marker of injury in athletes with groin pain: MR image appearance and interpretation. Radiology. 235(1):162-7, 2005
                                                                                                  16. Robinson P et al: Adductor-related groin pain in athletes: correlation of MR imaging with clinical findings. Skeletal Radiol. 33(8):451-7, 2004
                                                                                                  17. Meyers WC et al: Management of severe lower abdominal or inguinal pain in high-performance athletes. PAIN (Performing Athletes with Abdominal or Inguinal Neuromuscular Pain Study Group). Am J Sports Med. 28(1):2-8, 2000