Pubic apophysitis – an important cause of groin pain in young athletes

A 17-year-old male right-footed footballer presented with a 6-month history of left-sided groin pain which was persistent despite resting for 6 weeks. Pain occurred during running and daily activities including climbing the stairs and turning over in bed. On examination, the cardinal findings were tenderness of the pubic bone near the adductor insertion on the left side and pubic pain during resisted adduction. An initial pelvic radiograph was suboptimal due to overlying bowel gas but did show minor cortical irregularities (arrow, figure 1A) and features of an immature pubic symphysis including non-fused apophysis on the inferior side of the pubic symphysis and lower region joint lines are not yet fully ossified. MRI examination showed features, together with the clinical findings, that are typical for pubic apophysitis. There was bilateral extensive bone marrow oedema of the whole part shown of the pubic symphysis (arrow, figure 1B) on the coronal fat-suppressed sequence. A more focal high fluid signal along the left apophysis was also seen (arrow, figure 1C). Cortical irregularity on the left side with cystic and erosion-like configurations and widening of the pubic symphysis …