Abstract
A 31-year-old male ice hockey player presented with symptoms consistent with bilateral inguinal hernias further confirmed with imaging. After undergoing surgical excision, the patient continued to report pain. Further evaluation determined the patient’s pain seemed to be concentrated around the pubic region. Upon MRI reassessment, the patient demonstrated mild inflammation of the pubic symphysis from osteitis pubalgia (OP). Following this diagnosis, a new course of treatment was delivered with symptom elimination. This treatment was a methylprednisolone acetate 40 mg injection into pubic symphysis. It is essential to take into consideration not only the physical presentation, but also the activities that exacerbate the pain when making a diagnosis. Ice hockey includes repetitive motion from rapid acceleration, deceleration, and cutting on the ice, causing compression and separation at the pubic symphysis and inferior/superior glide. The constant shearing forces result in inflammation and dysfunction. Additionally, the muscular attachments at the pubic symphysis include pectineus, rectus abdominis, adductor longus, adductor brevis, and gracilis. Therefore, an injury to those muscles may cause secondary dysfunction of the pubic symphysis. Although the inguinal hernias were successfully treated, ultimately the patient’s pain resulted from OP, common in ice hockey. Given the close proximity of the pubic symphysis and muscular attachments to the inguinal canal, the likelihood of pubic symphysis stress is considerable. Given the close proximity of the pubic symphysis and muscular attachments to the inguinal canal, the likelihood of pubic symphysis stress is considerable. In cases like this, it raises the pivotal question: Which condition preceded the other? Was osteitis pubis (OP) pre-existing before the surgery, or did a pre-existing mild dysfunction of the pubic symphysis exacerbate following inguinal hernia repair? The challenge lies in the overshadowing effect of inguinal hernias on the diagnosis of OP. While imaging studies readily detect hernias, OP often eludes detection, particularly on MRI, and tends to be overlooked, especially when not initially suspected. Thus, while physical presentation and imaging remain crucial, recognizing physiological motion and predisposing factors is paramount for arriving at a comprehensive diagnosis.
Recommended Citation
Ricken RT, Short PD, Cornwell J, Bradley A, Volberding JL. Bilateral Inguinal Hernias versus Osteitis Pubalgia: A Case Study. The Internet Journal of Allied Health Sciences and Practice. 2024 Jun 26;22(3), Article 18.
