Imaging of Athletic Pubalgia and Core Muscle Injuries

The Hip in Ice Hockey: A Current Concepts Review

“…51 Noncontrast MRI could prove useful in pubic symphysis characterization (osteitis pubis due to core muscle injury), in addition to identification of rectus abdominis/adductor aponeurosis lesions or tearing or detachment of other structures from the pubic bone or symphysis itself (Fig 4A). 46,52,53 The use of US for diagnosing core muscle injury in elite athletes usually renders negative findings. 54 However, clinical use of US in identifying the associated pathology of core muscle injury is becoming more common (Fig 4B).…”

“…[43][44][45] Most recently, this condition has been labeled as "core muscle injury" because many clinicians believe it highlights the true pathophysiology of the injury. 46 The pubic symphysis acts as a fulcrum for the anterior pelvis and structures implicated in core muscle injury, including the external oblique fascia and muscle, internal oblique fascia and muscle, transverse abdominis muscle and fascia, and fascia transversalis. 47 The rectus abdominis, conjoined tendon, and external oblique merge and form the pubic aponeurosis, connecting with the adductor and gracilis origin.…”

Musculotendinous Disorders of the Abdomen and Pelvis

“…The musculoaponeurotic plate attachments at the pubic symphysis provide core stability to the anterior pelvis. 18 The complete anatomy of the attachments is complex and beyond the scope of this article, but the main attachments include the rectus abdominis and the adductor longus, adductor brevis, and pectineus at the fibrocartilage plate over the pubic symphysis. 18,19 This aponeurotic tissue blends with the anterior capsule and articular disk of the pubic symphysis (►Fig.…”

Injuries in Professional Football

“…Terms such as sports hernias and athletic pubalgia, or osteitis pubis, may be used to describe a constellation of symptoms where pain is common in the anterior or medial groin, or may be located directly over the pubic symphysis (44,74,94,95). Common subjective symptoms may include pain with strenuous activity, resolution of pain, or minimal pain with rest, and unilateral or bilateral inguinal and adductor pain.…”

“…However palpation can include tenderness of the lower abdominal/ inguinal ligament region, pubic tubercle, pubic symphysis, and the adductor muscles of the thigh. Pain generally is aggravated by running, cutting, hip adduction and flexion against resistance, and loading of rectus abdominis (27,41,44,74). Treatment is varied but typically starts with conservative measures (27,41).…”