EpistemisPubalgia
Specialty: Musculoskeletal.
Why it occurs
- Muscular imbalance between the adductors of the thigh and the rectus abdominis
- Biomechanical overload in athletes (football, rugby, running)
- Instability or shearing in the pubic symphysis
- Osteitis pubis (non-infectious inflammation of the symphysis)
- Adductor longus tendinopathy at its pubic insertion
- Inguinal or inguinal canal hernia ("sports hernia" or athlete's inguinal pain)
Initial workup
AP pelvis x-ray ("flamingo views" supporting one foot alternately to assess instability) | Magnetic resonance imaging of the pubic symphysis (method of choice to assess bone edema and enthesis ruptures) | Ultrasound of the inguinal region.
red flags
Severe and disabling inguinal pain associated with fever, local suppuration, or exquisite bone pain to direct pressure on the pubic symphysis with elevation of acute phase reactants (suggests osteomyelitis or septic arthritis of the pubic symphysis).
Standard management
- Etodolac — 400 mg every 12 hours orally, for systemic inflammation
- Chondroitin sulfate — 800 mg once a day, articular cartilage support in chronic pubalgia
- Local infiltration of corticosteroids or extracorporeal shock wave therapy directed at the common adductor tendon.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Musculoskeletal
- Listed causes
- 6
- Treatment options
- 3