| Pubic tubercle | Adductor tendon enthesopathy | Insidious onset, warms up with exercise | Guarding on passive abduction,9 weakness.10 Pubic “clock”: 6–8 | Magnetic resonance imaging11 |
| Rectus abdominis enthesopathy | Well localised to insertion, acute or insidious onset | Pain from resisted sit-up.10 Pubic “clock”: 12 | Magnetic resonance imaging11 |
| Pubic bone stress injury | Non-specific diminished athletic performance, loss of propulsive power | Bone tenderness predominates12 13 | Plain film,13 magnetic resonance imaging14 |
| Diagnosis of exclusion |
| Degenerative pubic symphysis | Central pain, associated with stress through symphysis—stair climbing | Tender over symphysis. Pubic “clock”: 3 | Plain film, stress view,15 magnetic resonance imaging14 |
| Incipient hernia; conjoint tendon tear | Insidious onset, diminished performance, warms up | Pain on resisted “torsion” of trunk “ipsilateral direction”.16 Pubic “clock”: 11 | Ultrasound17 |
| Incipient hernia; external oblique aponeurosis tear | Acute onset, related to sport-specific movement eg, “slap shot”.22 | Pain on resisted “torsion” of trunk “contralateral direction”.16 | Magnetic resosnance imaging18 |
| Tenderness and dilation of superficial inguinal ring on invagination of scrotum.23 | Confirmation by direct vision at arthroscopy19–21 |
| Pubic “clock”: 12–1 |
| Nerve entrapment; ilioinguinal nerve | Altered skin sensation | Superficial pain with or without hyper/dysaesthesia to skin over pubis.26 | Relief of pain by ultrasound-guided local anaesthetic infiltration27 |
| Genitofemoral nerve (genital branch) | Post inguinal surgery?24 | Absence of muscular component26 | Nerve conduction studies7 |