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ECR 2015 / C-2375
Athletic pubalgia: a detailed didactic approach
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Congress: ECR 2015
Poster No.: C-2375
Type: Educational Exhibit
Keywords: Athletic injuries, Education, Diagnostic procedure, Ultrasound, MR, CT, Musculoskeletal system, Musculoskeletal soft tissue, Anatomy
Authors: A. Corazza, A. Arcidiacono, S. Perugin Bernardi, R. Sartoris, D. Orlandi, E. Silvestri; Genoa/IT



The term “pubalgia” is commonly used to identify a groin painful syndrome often observed in amateur and professional athletes who play in sports that need quick acceleration and deceleration, rapid changes in direction, kicking and frequent side-to-side movements.


Clinically, athletes frequently present with insidious unilateral chronic pain (weeks or months) in the inguinal region which may radiate to the scrotum and testicles or to the medial thigh, at the level of the adductor muscles origin. This symptoms are typically exacerbated by physical activity; they often recur and may lead to the premature termination of athletic careers.


The clinical presentation is often similar to that of the inguinal hernia but at physical examination in most cases there is no palpable hernia.


A precise clinical overview is often difficult because many different pathologic conditions, both of muscolotendinous and visceral origin, can lead to groin pain.


To date, there is no real consensus on the criteria for a reliable diagnosis, despite many studies have investigated this pathologic condition in order to find a clearer correlation between anatomy, imaging and symptoms.


Many authors use the term pubalgia to refer to a group of musculoskeletal lesions that occur around the pubic symphysis and that share similar mechanisms of injury and common clinical manifestations. The causal mechanisms of athletic pubalgia are poorly understood but many athletes have a spectrum of related pathologic conditions resulting from musculotendinous injuries and subsequent instability of the pubic symphysis.


The complex anatomy and biomechanics of the pubic symphysis region can create diagnostic confusion. It includes a number of interrelated muscle attachments that are located in close proximity to one another; the interrelation of these muscle attachments causes complex interactions between the forces exerted through the muscles across the pubic symphysis.




We will provide a practical but detailed approach with dedicated MR and dynamic US scan coupled with anatomic scheme, regarding each of the following structures: pubis, pubic symphysis, parasymphyseal structures, rectus abdominis muscle, adductor longus, adductor brevis, adductor magnus, gracilis and pectineus muscles.


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