[image: pubalgia cor.jpeg]
I don’t see an Adductor strain.
On the anteroinferior to the left there seems to be a chondral avulsion at
the insertion of the arcutate ligament (red arrow) and the pubic plate (bue
arrow).
I don’t see a cleft. Seems to be a bit much fluid in the anterior capsule.
Do you agree? Or is there something else going on here?
He is off to collegiate football and pain limits his running speed.
[image: pubalgia 2.jpeg]
[image: 1 pubalgia.jpeg]
[image: c98dc2fb-cee0-4fa6-bf47-c084c86acdb9.jpg]
[image: 71367f93-074c-4c32-9687-08f67cfa888d.jpg]
[image: b41261af-48c9-4b0b-8ca1-4aefae87a72c-1.jpg]
[image: f5c8154b-712f-47d4-971a-354fb6c30e77-1.jpg]
[image: 09551805-4496-44b0-af41-89841ecd1a2d-1.jpg]
Screenshots (from my phone, sorry) Left to Right….I was asked to send
Sagittals
On Fri, Jul 23, 2021 at 10:41 AM hilary umans <hilary.umans@gmail.com>
wrote:
[gallery]
This is a pattern we see in young males, Hilary.
In the cor image to the right of the one with the red arrow, there is a secondary cleft. And its a variant of cleft that might be termed a “posterior secondary cleft”, implying that the right pubic plate is disrupted from the periosteum poteroinferior to the pubic tubercle.
Then on the sag, right of midline, there is a little breech in the plate at the pubic tubercle, but it extends posterior and inferior.
These can be really symptomatic and can also lead to bigger injuries. I think your choices include trying an US guided tenotomy followed by a couple of weeks of rest, or direct him to Vincera, where he will likely get a core muscle repair.
If you want to try tenotomy, you will see the breech in a sag plane with US. Find it and then repeatedly pepper the plate below the breech into the periosteum. You can optionally follow with a bit of steroid (I know, counterintuitive, but tends to work).
Adam
Sent with my thumbs
The information contained in this transmission contains privileged and confidential information. It is intended only for the use of the person named above. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution or duplication of this communication is strictly prohibited. If you are not the intended recipient, please contact the sender by reply email and destroy all copies of the original message.
CAUTION: Intended recipients should NOT use email communication for emergent or urgent health care matters.
I discussed this further with Adam Zoga…who simply forgot to comment on
the more obvious left sided injury—he was distracted by the changes on
the Right.
He said: the injury is anterior on the left & posterior on the right. On
the left, the pubic apophysis never fused, so the BME reflects instability.
That unfused osseous fragment is in the left plate, so it hurts.