Longstanding Groin Pain in Athletes

Abstract

In 21 male athletes (age 20 to 40 years) with longstanding unexplained groin pain, a multidisciplinary investigation was performed in order to reveal the underlying cause. These examinations included general surgery for detection of inguinal hernia and neuralgia, orthopaedic surgery for detection of adductor tenoperiostitis and symphysitis, urology for detection of prostatitis, radiology for performing herniography and plain film of the pelvic bones, nuclear medicine for isotope studies of the pubic bone and symphysis. In 19 patients there was a positive diagnosis for 2 or more of the diseases (10 patients had 2 diseases, 6 patients had 3 diseases, 3 patients had 4 diseases). Two patients had only signs of symphysitis. Our results show the complexity of longstanding groin pain in athletes. It also explains why therapy for one specific disease entity may fail. We conclude that this clinical setting demands the recruitment of a team with experience of different aspects of groin pain.

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“…Magnetic resonance, although being an expensive examination, which is extremely rarely used in the public health system in Romania for establishing the diagnosis of hernia, was proven in the studies we analyzed in this research superior to tomography because it visualizes all structures, the inguinal canal, inferior epigastric vessels, the inguinal ligament, inguinal rings, the spermatic cord, and allows differential diagnosis of pubic inguinal pain syndrome (Ekberg et al, 1988;Deysine, Deysine and Reed, 2002). The European Hernia Society recommends a standard protocol that initially consists of ultrasonography, and if this is negative, MRI associated with the Valsalva maneuver will be performed; if this investigation is also negative, herniorrhaphy will be taken into consideration.…”

“…Sometimes patients had pain in tensioning the long adductor. The classic presentation of inguinal hernia in the form of a pseudotumoral mass in the inguinal region, with impulsion and cough expansion, was often absent (Campanelli, 2010;Fon & Spence, 2000;Ekberg et al, 1988). Clinical examination identified the dilation of the external inguinal ring, but without a pseudotumoral groin mass.…”

Presence of Inguinal Hernia in Soccer Players with Osteitis Pubis

“…Sporcularda kronik kasık ağrısı tek bir patolojiye bağlı olabileceği gibi, birden fazla patolojinin eş zamanlı varlığına da bağlı olabilir (6,7). Konuya ilişkin literatür verileri kısıtlıdır.…”

Pubic inguinal pain syndrome: the so-called sports hernia

“…Gullmo refers that pain in these circumstances may be caused by a distension of peritoneum or stretching of the ilioinguinal nerve [2-4, 14, 15]. There has been recent interest in neurogenic groin pain: Lovell et al have studied the clinical presentation of inguinal neuralgia in a series of athletes with groin pain [1,3,4,15,16]. Obturator neuropathy has been described in a series of 32 patients, but the nerve entrapments in the inguinal region include those of the genitofemoral and ilioinguinal nerves, which cause local pain and neurological dysfunction [1-3, 17, 18].…”

“…The majority of patients complain of unilateral inguinal pain, often radiating to the pubic tubercle and inner thigh or across the midline, and may recall the speciWc event that initiated the pain, but, more often, the onset is insidious, and the patients associate activities such as kicking, sprinting or cutting with the elective pain. The symptoms are exacerbated by activity and temporarily relieved with rest [1,2,11,15,22]. The pain often manifests as a point tenderness over the pubis at the rectus abdominis muscle origin.…”