Table 1 Patho-anatomical approach: pubic tubercle region (diagnoses appear in order of frequency in an athletic population)
Define and alignPathologyListen and localisePalpate and re-createAlleviate and investigate
Pubic tubercleAdductor tendon enthesopathyInsidious onset, warms up with exerciseGuarding on passive abduction,9 weakness.10 Pubic “clock”: 6–8Magnetic resonance imaging11
Rectus abdominis enthesopathyWell localised to insertion, acute or insidious onsetPain from resisted sit-up.10 Pubic “clock”: 12Magnetic resonance imaging11
Pubic bone stress injuryNon-specific diminished athletic performance, loss of propulsive powerBone tenderness predominates12 13Plain film,13 magnetic resonance imaging14
Diagnosis of exclusion
Degenerative pubic symphysisCentral pain, associated with stress through symphysis—stair climbingTender over symphysis. Pubic “clock”: 3Plain film, stress view,15 magnetic resonance imaging14
Incipient hernia; conjoint tendon tearInsidious onset, diminished performance, warms upPain on resisted “torsion” of trunk “ipsilateral direction”.16 Pubic “clock”: 11Ultrasound17
Incipient hernia; external oblique aponeurosis tearAcute onset, related to sport-specific movement eg, “slap shot”.22Pain on resisted “torsion” of trunk “contralateral direction”.16Magnetic resosnance imaging18
Tenderness and dilation of superficial inguinal ring on invagination of scrotum.23Confirmation by direct vision at arthroscopy1921
Pubic “clock”: 12–1
Nerve entrapment; ilioinguinal nerveAltered skin sensationSuperficial pain with or without hyper/dysaesthesia to skin over pubis.26Relief of pain by ultrasound-guided local anaesthetic infiltration27
Genitofemoral nerve (genital branch)Post inguinal surgery?24Absence of muscular component26Nerve conduction studies7