Adductor Musculotendinous Junction Pathology (" Pubalgia "): Ultrasound Evaluation
- Dr. Segnini
- Jan 16
- 3 min read
Groin Pain in Athletes
The condition known as " pubalgia ," or chronic groin pain in athletes, is frequently a pathology of the musculotendinous junction of the adductor muscles at their pubic insertion. It is a common overuse injury in soccer, hockey, and sports involving sudden changes of direction. High-resolution musculoskeletal ultrasound is the ideal technique for dynamically, rapidly, and comparatively evaluating this complex region (with the asymptomatic leg).
The Value of Ultrasound in the Diagnosis of Pubalgia
Direct Anatomical Evaluation: Visualizes in detail the tendons of the adductor longus, adductor medius, rectus abdominis and the pes anserinus muscles at their pubic insertion.
Dynamic Mode: Allows the study of tendons at rest and during isometric contraction or against resistance, identifying functional tears or subtle instabilities.
Accurate Differential Diagnosis: Distinguishes adductor tendinopathy / entesopathy from other causes of groin pain such as hernias (inguinal, sports), bursitis, or pubic symphysis joint pathology.
Identification of Complications: Detects insertional calcifications , partial or complete tears, and signs of pubic osteitis.
Treatment Guide: Essential for performing precise ultrasound-guided infiltrations (with corticosteroids, platelet-rich plasma - PRP) at the exact point of the lesion.
Key Ultrasound Findings by Pathology
A) Enthesopathy / Adductor Tendinosis (Chronic Overuse Injury):
Findings: The affected tendon (mainly adductor longus ) loses its normal fibrillar structure and appears thickened and hypoechoic (darker) at its pubic insertion.
Bone Changes: There may be irregularity or erosion of the bone cortex at the point of insertion ( enthesis ).
Color/Power Doppler : Shows increased vascular signal ( neovascularization ) inside the thickened tendon, a sign of pathological activity and repair.
Dynamics: The pain is reproduced when requesting isometric contraction against resistance with the transducer in the area.
B) Partial or Complete Tear (Rupture):
Partial Tear: Focal interruption of the tendon fibers, which appears as a well-defined anechoic or hypoechoic area . In acute cases, there may be an associated hematoma.
Complete Tear: Retraction of the ends of the ruptured tendon with a hypoechoic gap (space) filled with hematoma. Loss of normal tendon tension.
C) Pubic Osteitis (Bone Involvement):
Findings: Irregularity and hyperemia of the pubic symphysis cortex. Edema may be observed in the subchondral bone ( hypoechoic area ) and subchondral cysts .
Doppler : Shows hypervascularization in the area of the symphysis and adjacent tendon insertions.
D) Critical Differential Diagnosis with Dynamic Ultrasound:
Sports Hernia ( Athletic Pubalgia ): Defect of the posterior wall of the inguinal canal, with pain upon compression of the transducer and protrusion of abdominal contents during Valsalva .
Direct/Indirect Inguinal Hernia: It is evaluated with Valsalva maneuvers to see protrusion of the contents through the inguinal ring.
Iliopectineal Bursitis : Fluid in the bursa located between the iliopsoas tendon and the hip joint capsule.
Limitations and Considerations
The evaluation requires a thorough anatomical knowledge of the inguinal and pubic region.
ultrasound-guided palpation .
In complex cases or for a more comprehensive evaluation of the pubic symphysis, it may be complemented with a Magnetic Resonance Imaging (MRI).
Conclusion:
Ultrasound is the natural extension of the physical examination for athletes with chronic groin pain. Its ability to perform real-time anatomical and functional assessment makes it the tool of choice for accurately diagnosing adductor pathology, guiding minimally invasive treatments, and ruling out other causes of pain, thus accelerating a safe return to athletic activity.
Pubalgia ultrasound
Dr. Jose Segnini, Radiologist / Diagnostic Medical Sonographer
MD Radiologist (Venezuela – Chile)
Board Certified Diagnostic Medical Sonographer (ARDMS, USA)
Mobile Ultrasound & Medical Supplies – Orlando, Florida
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