Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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F.J. Brody and J. Harr
Physical Exam
On physical examination , he was exceedingly fit with minimal body
fat, pronounced abdominal muscles, and large quadriceps. His abdomen
was flat without overt hernia defects. Upon palpation, the left groin was
tender, particularly cephalad to the pubic bone at the insertion of the left
rectus abdominis . His tenderness extended toward the pubic tubercle and
laterally for 2 cm into the inguinal crease. Active sit- ups, with or without
resistance, replicated his groin and abdominal pain. He was also tender
along the left adductor longus tendon starting at the inferior aspect of the
pubic tubercle, and extending along the tendon for 10 cm. The adductor
tendon pain was exacerbated with hip adduction and abduction. He had
full range of motion of his hip, and there were no clinically evident
inguinal hernias even after multiple Valsalva maneuvers.
Workup
Plain radiographs did not show evidence of femoroacetabular
impingement, hip dysplasia, or lumbar or sacroiliac degenerative
changes. There was also no evidence of bone resorption or sclerosis.
Magnetic resonance imaging (MRI) of the abdomen and pelvis revealed
high signal uptake on T1- and T2-weighted images along the pubic bone
consistent with pubic osteitis. There was also increased uptake along the
left rectus abdominis insertion at the pubic bone consistent with edema
and a possible tear. A cleft sign was also visible along the inferior portion
of the pubic bone at the insertion of the left adductor longus , signifying
a tear of the tendon (Fig. 36.1a, b ). There was no evidence of any
associated intra- articular hip pathology.
Diagnosis
The history, physical exam, and radiologic findings were consistent
with the diagnosis of a sports hernia with adductor tendonitis . Other
differential diagnoses should include iliopsoas strains or bursitis, avulsion
injuries of the pubic bone, nerve entrapment syndromes, stress
fractures of the femoral neck or pubic rami, vertebral body pathology,
and associated hip injuries [ 1 ]. The most common hip pathology associ-