Diagnosis of Pubalgia
How is Pubalgia usually diagnosed?
A diagnosis is usually determined by a combination of assessment of the patients previous health history, a physical examination and diagnostic tests. Diagnostic tests include orthopedic and surgical examination as well the use of imaging techniques such as ultrasound, x-ray, CT or MRI scans and electrophyography. Most commonly, the catalyst in a valid diagnosis is thorough examination using various angles with MRI imaging scans as well as bone scans to reveal any inflammation to the pubic bone. Physicians are able to run test panels to determine if there has been any damage to bones or tissues in the areas effected as well as if an infection exists which could potentially be triggering the pain. (which is quite serious, and a very good reason to get checked by your physician if pain persists for more than a week.).
Usually during examination of inguinal incision as well as exploration of the external oblique aponeurosis, it is discovered that there is a small tear in the External Oblique aponeurosis near the emergence of the neurovascular bundle associated with the terminal branches of the
Pubalgia may be misdiagnosed during an initial visit to a primary care physician as groin pain associated with normal exercise. The physician may recommend rest as well as the application of ice as well as heat to quell the symptoms of pain, anti-inflammatory drugs and physical therapy; Otherwise known as conservative treatment. Pubalgia may be quite difficult to diagnose for a primary care physician. Diagnostic confusion is often derived from the complex nature of the anatomy and biomechanics of the pelvic region and pubic symphysis. There are a large number of muscles, tendons, and nerves in the pelvic region and thus a large number of potential sources of groin pain. Each of these sources of pain may have similar symptoms, but have different sites of the actual injury. Much of the confusion in diagnosis also relates to the fact that previously the complicated anatomy of the anterior pelvic region was not a surgical specialty or concentration within medical science, and therefore less emphasis was placed on physicians familiarizing themselves with the complex anatomy of the region. The pelvic region was in effect "no mans land" for a wide range of specialties until recently. If conservative therapy does not relieve the symptoms of Pubalgia, your physician will most likely refer you to a specialist for further evaluation. Pubalgia has a spectrum of related pathological conditions which result from musculotendinous injuries and the subsequent instability caused in the region of the pubic symphysis. Pubalgia is usually the diagnosis when there is no indication of inguinal hernia upon physical examination.
The actual mechanism of athletic Pubalgia are poorly understood, in the past, imaging studies have been deemed inadequate or unhelpful in the use of diagnosing Pubalgia. Magnetic Resonance Imaging is now more reliable for helping to diagnose athletic Pubalgia as opposed
Most commonly, MRI and surgery results have shown that the prevalence of the injury originating along the lateral border of the Rectus Abdominis just superior to its pubic attachment, or at the origin of the Adductor Longus. With either of these injuries there is a repetitive unbalanced contraction in antagonistic muscle causing it to be locked short and distorting our bodies natural way of dealing with the stresses and forces exerted on the pelvic region. This lack of opposing force can then lead to degeneration and tearing of tendons which were not initially involved in the injury. Our body can be paralleled to an intricate tensegrity structure; when a certain element of the structure is out of alignment or not operating correctly, the balance is disrupted and the integrity of the entire structure is compromised. Once this integral harmonious balance is disrupted it leaves the body open to further pathological conditions and injuries. It is for this reason that Pubalgia pain may actually result from the initial injury as well as the chronic repetitive stresses to the antagonistic tendons and ligaments or the destabilized pubic symphysis.