The pubic symphysis is a secondary cartilaginous joint with a fibrocartilaginous interpubic disc reinforced by the superior pubic ligament, the arcuate ligament inferiorly, and the anterior pubic ligaments. Pubic symphysis dysfunction from childbirth, high-impact sport, or femoroacetabular impingement produces groin pain at the midline that radiates to the adductors. Osteitis pubis — bone marrow oedema and subchondral erosion — is the most common radiological finding in athletes with groin pain.
The pectineal line palpation test (tenderness directly over the pubic symphysis) and the active straight leg raise test (pain at the symphysis during ASLR) are the key clinical assessments. MRI shows bone marrow oedema and disc signal change. Management: load modification, adductor strengthening (not stretching), targeted physiotherapy — surgery (wedge resection or fusion) is rarely required.
Pubic symphysis bone marrow oedema and disc degeneration from athletic overload producing midline groin pain managed with load modification and progressive adductor loading.
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