Medical Imaging Analysis Report

I. Imaging Findings

Based on the provided pelvic MRI images:

• Localized T2 signal hyperintensity can be seen at the pubic symphysis region and the corresponding tendon attachment sites (primarily involving the superior and inferior borders of the pubic ramus), suggesting inflammation or injury at the soft tissue or tendon attachment points.
• In some images, a high-signal “cleft” sign (possibly the “secondary cleft sign” or “superior cleft sign”) can be observed between the inferior side of the pubic bone and surrounding ligaments or tendons, with coordinates corresponding to the junction of the pubis and tendons (such as the adductor tendon and rectus abdominis tendon).
• No obvious fracture line or extensive bone edema is noted, but there is mild bone marrow edema-like change in the pubic region, consistent with chronic traction or overuse.
• No evident protrusion of the inguinal hernia sac is observed, and there is no significant structural abnormality of the femoral head or hip joint capsule.

II. Possible Diagnoses

Based on the patient’s clinical presentation (sudden onset, persistent groin pain after exercise) and imaging features, the following diagnoses should be considered:

1. Athletic Pubalgia (“Sports Hernia”)
   • Cause: High-intensity physical activity leading to repetitive traction of tendons or soft tissues, especially at the attachment sites where the abdominal wall and adductor muscles intersect.
   • Imaging Characteristics: MRI often shows a “cleft” sign (secondary or superior cleft sign), suggesting injury at the attachment of the adductor and rectus abdominis tendons.
2. Adductor Tendinitis or Partial Tendon Tear
   • Cause: Prolonged overuse or acute overstretching of the adductor muscles.
   • Imaging Characteristics: On MRI, there may be edema around the tendon and areas of mild tear showing high signal intensity.
3. Pubic-related Groin Pain (Osteitis Pubis)
   • Cause: Chronic mechanical traction or abnormal local load leading to inflammation of the pubic symphysis and surrounding periosteum.
   • Imaging Characteristics: The pubic symphysis region may show soft tissue swelling and bone marrow edema. In severe cases, the joint line may appear blurred or irregular.
4. Other Groin-related Lesions
   • For instance, inguinal hernia, iliopsoas injury, or hip labral pathology. These are typically supported by corresponding imaging or physical examination findings; currently, no obvious positive findings are noted in this imaging.

III. Final Diagnosis

Considering the patient’s youth, professional soccer career, acute onset with no significant history of trauma, severe groin discomfort after high-intensity competition, and the notable “cleft” sign found on MRI, the findings most closely align with a diagnosis of “Athletic Pubalgia” (commonly referred to as “Sports Hernia” or “Gilmore’s Groin”).

If uncertainty persists, further evaluation can be considered (for example, dynamic ultrasound for suspected inguinal hernia or a more comprehensive MRI sequence of the pubic region). However, based on the current data, the diagnosis is well supported.

IV. Treatment Plan and Rehabilitation

1. Conservative Management

• Rest and Activity Reduction: Initially avoid activities that excessively stress the pubic region, and appropriately reduce high-intensity competitions or training sessions.
• Medication Management: Under the guidance of a specialist, non-steroidal anti-inflammatory drugs (NSAIDs) or local anesthetic injections (such as lidocaine) may be used to alleviate pain and inflammation.
• Physical Therapy: Includes ultrasound therapy, manual relaxation, and muscle stretching to promote local blood circulation and reduce soft tissue tension.

2. Rehabilitation and Exercise Prescription

Rehabilitation should follow the FITT-VP principles (Frequency, Intensity, Time, Type, Volume/Progression):

• Early Recovery Phase (Weeks 1–2):
  • Frequency: 3–4 times per week, with rest days in between.
  • Intensity: Low intensity; avoid excessive stress on the groin, e.g., gentle core stability exercises or low-speed cycling.
  • Time: 20–30 minutes per session.
  • Type: Focus on strengthening the transversus abdominis and pelvic stabilizing muscles, along with gentle stretching of the adductors and iliopsoas.
  • Progression: As pain subsides, gradually extend training duration and attempt small-scale core functional strengthening.
• Intermediate Strengthening Phase (Weeks 3–5):
  • Frequency: Approximately 4 times per week.
  • Intensity: Moderate intensity; introduce mild resistance exercises such as elastic band hip abduction/adduction and bridge exercises.
  • Time: 30–40 minutes per session, still ensuring no induced pain or discomfort.
  • Type: Isometric and isotonic exercises for core muscles combined with posture correction and proprioception training.
  • Progression: Gradually increase resistance loads, steadily enhancing coordination between the groin and lower limb muscle groups.
• Late Return-to-Play Phase (Week 6 and Beyond):
  • Frequency: Maintain 3–4 sessions per week, monitoring pain response after each session.
  • Intensity: Gradually integrate ball-related training or running drills, moving from low to high intensity.
  • Time: Adjust flexibly according to sport-specific demands, ensuring proper warm-up and cool-down.
  • Type: Sequentially introduce sprinting, agility drills, and other sport-specific exercises while closely monitoring groin stress.
  • Progression: Before returning to competitive level, ensure the absence of pain or discomfort, with sufficient strength and endurance in the lower limbs and core muscles.

3. Surgical Indication

For professional athletes or those who do not recover after prolonged conservative treatment, surgical intervention such as inguinal repair or tendon repair may be considered under specialist evaluation. Post-operative rehabilitation still requires strict adherence to training protocols.

Disclaimer

This report is a reference analysis based on the provided case information and imaging data. It does not constitute a complete diagnosis equivalent to an in-person medical evaluation. Specific treatment plans must be combined with clinical examination, laboratory tests, and the opinions of professional physicians. If you have any questions or if your condition changes, please seek medical attention or consult a professional promptly.