Athletic Pubalgia

Abstract

Diagnosis of athletic pubalgia can be elusive, but is established by history and physical examination. It can be found in recreational athletes. An open approach using mesh relieves the pain and restores activity.

Proposed Algorithm for the Management of Athletes With Athletic Pubalgia (Sports Hernia): A Case Series

“…in high-performance recreational, high school, and collegiate athletes, 1 and the escalading incidence of reports in prominent professional athletes may be partially explained by heightened media awareness. 40,52,59,75 The higher reported incidence of this condition in males versus females 4,37,46,52,61 may be explained by a greater level of participation in highly competitive sports and/or gender differences in pelvic anatomy.…”

“…53,58,62 Symptoms are usually unilateral, although pain often starts unilateral and progresses to become bilateral. 1,22,58,61,80 Symptom presentation is typically insidious; however, most patients recall a subsequent acute event occurring after groin pain was already present. 39,53,59,61,75,80 The pain is usually exacerbated by kicking, sprinting, sidestepping, cutting, and/or performing sit-ups.…”

“…58 Further evaluation of female athletes often reveals a gynecological source to their symptoms, including endometriosis and ovarian cysts. 1,46,58,61 The hallmark symptom of athletic pubalgia is a complaint of "deep" groin or lower abdominal pain with exertion 40,58,80 that is relieved with rest but returns upon resumption of sport-related activities. 22,39,58,80 The groin pain is described as deeper, more proximal, and more intense than an adductor or iliopsoas strain.…”

“…40,48,50,53,58,63 If there is preoperative involvement of the adductor longus tendon, the surgeon may opt to concurrently perform an adductor tenotomy-typically fractional lengthening. 1,2,5,50,53,58,80 The increasingly common laparoscopic procedure involves preperitoneal insertion of a polypropylene mesh, 1,22,39,46,63,74,80 resulting in less postoperative pain, smaller incisions, faster recovery rate, and has the additional advantage in that a diagnostic scope can be immediately followed by the repair. 46,61,80 Early outcome studies utilizing laparoscopic repair indicate high success in rates of return to preinjury level of play within 3 to 6 months.…”

“…40,51,58,80 Prospective validation studies of athletes undergoing surgical repair of a sports hernia, along with examination findings of 3 of the participants in this case series who subsequently underwent repair, reveal a cluster of 5 signs and symptoms to be the most indicative of a sports hernia: (1) a subjective complaint of deep groin/ lower abdominal pain, (2) pain that is exacerbated with sport-specific activities such as sprinting, kicking, cutting, and/or sit-ups and is relieved with rest, (3) palpable tenderness over the pubic ramus at the insertion of the rectus abdominis and/or conjoined tendon, (4) pain with resisted hip adduction at 0°, 45°, and/or 90° of hip flexion, and (5) pain with resisted abdominal curl-up. 1,22,39,58,80 The role of diagnostic imaging, including magnetic resonance imaging (MRI), computed tomography (CT) scans, and bone scans, in the diagnosis of a sports hernia is debated. Many studies report MRI has limited ability to diagnose a sports hernia and is beneficial only to rule out alternative diagnoses.…”