HSS Ultrasound of the Month Case #95

Clinical History 43 year old male with groin pain related to playing soccer.

Ultrasound of the Month – Case 95

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Diagnosis: Osteitis Pubis

Discussion Osteitis pubis is part of a spectrum of injuries that can result in groin pain or athletic pubalgia.

Athletic pubalgia, the definition of which overlaps with “sports hernia”, is common with sports that involve excessive twisting and shear-type stress at the pubic symphysis, such as soccer, ice hockey, and Australian-rules football.

Osteitis pubis is thought to be a result of microinstability at the pubic symphysis, and subchondral irregularity and bone marrow edema are hallmarks on MRI. Treatment for osteitis pubis and other sources of athletic pubalgia include rest and strengthening of the surrounding core muscles.

Long-term role of cortisone injection is uncertain; however, it can provide therapeutic relief in patients who have not adequately recovered after other modes of therapy.

Although pubic symphyseal injection can be performed under fluoroscopy or even CT guidance, ultrasound guidance is fast, avoids radiation exposure, and is safe if done by experienced hands.

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