This is Barry Belosis, one of the musculoskeletal radiology fellows at Stanford University. 46 year old male active-duty naval aviator and amateur soccer coach with anteromedial left thigh and groin pain concerned for adductor tear. The patient in this case presented with this coronal T2 fat set of the thigh. And here we can see a high-grade tear of the adductor longus with retraction of the torn fibers as seen here. A quick review of our anatomy here demonstrates that the rectus abdominis muscle continues with the adductor longus distally and drapes over our pubic symphysis as we can see here. This is the adductor longus and the rectus abdominis muscle. On a different patient, this is a 45 year old man with groin pain after intensive squatting. For those with suspicions for athletic pubulgia, pelvic radiograph could be obtained for further evaluation of any bony abnormalities. However, patients with athletic pubulgia will often have normal radiograph. On the same patient, an MRI pelvis without contrast was performed. We do an athletic pubulgia protocol with different angulation towards the pubic symphysis. In sagittal T2 fat set imaging here, we can see that deep to the rectus abdominis adductor aponeurosis is an increased signal consistent with partial tearing. There is also associated bone marrow edema of the adjacent left pubic bone. On the axial oblique T2 fat set, again, we can see this edema within the left pubic bone and an increased signal just deep to the left adductor longus attachment, which is in comparison to the normal right side here, which we don't see any increased signal. On our coronal T2 fat set imaging, we can see increased signal here between the attachment of the adductor longus and the left pubic bone compared to the normal right side where we just see hypointensity between the adductor longus and the right pubic bone. If we move posterior-inferior, here we can see the normal cleft between the pubic symphysis. However, this cleft in the left side is abnormal and should not be seen. This is consistent with a short adductor tear. of the adductor muscles. Again, we can see some bone marrow edema of the adjacent left pubic bone consistent with stress injury or stress reaction. On the contralateral right side, the short adductor is normal. This is in a different patient, a 26-year-old NBA forward. Here on our coronal T2 fat set imaging, we can see an isolated tear of the adductor longus at the pubic attachment. Also seen here is this defect between the tendon and the pubic bone on our coronal T1 imaging. This is an acute injury on a 42-year-old after ultimate frisbee. Here we can see on our axial oblique T2 fat set, we can see this hypointensity in the left groin region with extensive surrounding edema. Also some edema here in our left pubic bone. This is consistent with high-grade tearing of the adductor muscles from the pubic bone. When we look at this in our coronal imaging, here's the left side is our coronal T1 and the right is our coronal T2 fat set, we can see that on the left-hand side, the adductor tendons are retracted distally from its pubic bone attachment. Athletic pubalgia instead of sports hernia is the preferred term. It is a group of MSK or musculoskeletal processes that occur in and around the pubic symphysis. Most commonly involve the common aponeurosis of the rectus abdominis and adductor muscles, particularly the adductor longus. Dr. Christopher Beaulieu has an excellent video in YouTube describing the groin pain in athletes which goes in more depth for the anatomy and abnormality seen within the groin area.

2nd Edition, CASE 53

2nd Edition

Thigh

groin pain

adductor longus

athletic pubalgia

sports hernia

Dr. Christopher Beaulieu