Local anesthetics are typically recommended for diagnostic purposes. The local anesthetic delivered directly to the area of pain is a rapid way to confirm that the area being injected is truly the pain generator. It also will help to determine if subsequent injections with the other agents listed above may be helpful. If temporary relief of the groin pain is accomplished, then it makes it more likely that they will respond to a therapeutic intervention.

Corticosteroid injections are also an option for chronic groin pain, depending on the area of involvement. Corticosteroids provide a rapid anti-inflammatory effect to the targeted area. We have found that corticosteroids when delivered judiciously can serve as a powerful modality for alleviating the pain and soreness associated with the sports hernia.

Our preferred technique for injections in and around the peri-inguinal region is with ultrasound guidance. Deleterious effects can occur if a corticosteroid is injected directly into a major nerve branch or other important structure such as the vas deferens, spermatic cord, or other nearby urologic structures. The ultrasound is used in an effort to ensure safe delivery of the corticosteroid into a zone that is free of one of these important anatomic structures. Therefore, our goal for injection is first and foremost the avoidance of important traversing structures as per above, and secondly to deliver the corticosteroid into the area of maximal tenderness. With recent improvements in high resolution ultrasound probes, previously unrecognizable sensory nerve branches can sometimes be visualized. Therefore, an effort is made to identify the suspected entrapped nerve branches. However, delivery of the corticosteroid is performed regardless of direct identification of the sensory nerve.

Unfortunately, the relief is often short-lived and many of the athletes develop a recurrence of pain. When the athlete does respond favorably to the injection, significant relief can be expected for an average of 4–6 weeks at which time the decision for re-injection can be entertained. It is our opinion that one or two mid-season injections can be administered with minimal risk; however, further injections should be given cautiously for fear of weakening the already compromised surrounding soft tissue structures that could theoretically place the athlete at risk for more significant injury and microtrauma. If the athlete has a recurrence after two corticosteroid injections into the same area in a single season then the recommendation for surgical intervention is made at that time.

Perhaps the clearest indication for use of corticosteroids is for the treatment of osteitis pubis. Many athletes with pubalgia will present with concomitant tenderness in the pubic symphysis. Pubic symphysitis or osteitis pubis can also present as a stand-alone diagnosis in and of itself. In an effort to treat the symphyseal pain in a conservative fashion, image-guided symphyseal cleft injection can prove useful in mitigating this pain [5]. Typically, a low-dose injectable corticosteroid is delivered to the symphyseal cleft in an effort to diminish the inflammation in this joint. This can be an effective technique for not only allowing the athlete to continue to compete through the remainder of a season but in some cases can obliterate the osteitis pubis altogether and, therefore, allow successful treatment of this disorder without the need for surgical intervention.