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

7. Groin Pain Etiology: Athletic Pubalgia Evaluation…
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Fig. 7.2. Tendon tear in the adductor longus at the pubic bone. Note the
increased tissue edema indicated by the smudged appearance of the tissue.
aggravating activities is mandated. The mainstay treatment is typically
nonoperative, most commonly beginning with 6 weeks of rest, though
low-impact and cardiac workouts can often be tolerated. Daily scheduled
nonsteroidal anti-inflammatory medications are prescribed as tolerated.
After the 6 weeks of rest, a rehabilitation program focused on
cross-training types of stretching and lifting exercise can be started with
a physical therapist [ 12 ]. The goal with rehabilitation is to establish
muscular balance between the adductor and abdominal regions, thereby
reducing the risk of early reinjury. Fricker et al. reported an average time
to full recovery after conservative treatment of 9 months for men and
7 months for women [ 13 ]. If symptoms do not resolve after rest and
rehabilitation programs, a corticosteroid injection treatment may be
considered. A 3 mL mixture of 1 % lidocaine, 0.25 % bupivacaine, and
4 mg of dexamethasone injected into the interpubic disk of the pubic
symphysis has reported good results in immediate pain relief and progression
to full activities in a case series [ 14 ].