Introduction
Athletic Pubalgia, previously known as sports hernia, manifests as persistent lower abdominal and groin pain. It’s a prevalent issue among athletes, often accompanied by additional complications, necessitating a nuanced approach to evaluation.
Case:
A 22-year-old young male presented to our radiology department of our hospital with complaints of left groin pain which worsens with hip flexion and running
Discussion:
At the core of this condition lies the pubic symphysis, serving as a pivot point for the anterior pelvis. Here, the convergence of the rectus abdominis and adductor longus forms a crucial sheath, pivotal for pelvic stability during dynamic movements.
Intense athletic activities exert significant force on this region, with the pubic symphysis bearing the brunt. The tug-of-war between the adductor longus and rectus abdominis at this fulcrum likely initiates the pathology of athletic pubalgia. When the rectus abdominis weakens, the adductor longus pulls unopposed, leading to myotendinous or osseous injury at the pubic symphysis in athletes due to repetitive micro trauma (1)
The prevalence of athletic pubalgia is higher in males, Common in football (soccer), ice hockey, rugby players (2).
MRI findings includes osteitis pubis as well as strains or tears of rectus abdominis, RA-AL (Rectus abdominis and Adductor longus) aponeurosis, or adductor longus and Secondary cleft sign describes curvilinear fluid continuous with pubic symphysis that undermines attaching structures at the pubic symphysis, which reflects a tear of the adductor longus origin or RA-AL aponeuroses.
Osteomyelitis and Hyperparathyroidism present as potential differential diagnosis, highlighting the importance of considering infectious and metabolic etiologies alongside.
References:
- Cohen, Brian & Kleinhenz, Dominic & Schiller, Jonathan & Tabaddor, Ramin. (2016). Understanding Athletic Pubalgia: A Review. Rhode Island medical journal. 99. 31-35.
- Meyers, W. C., Foley, M. P., Garrett, J. M., & Lohnes, J. C. (2003). Athletic Pubalgia and the “Sports Hernia”: MR Imaging Findings. Radiology, 227(3), 712-718. doi: 10.1148/radiol.2273020364
Dr. Kanagasabai Kamalasekar
Consultant Radiology
Kauvery Hospital, Chennai
Dr. Manish Yadav
DnB Radiology Resident
Kauvery Hospital, Chennai