Outcomes following surgical management of inguinal-related groin pain in athletes: a case series

Abstract

To determine the outcomes of a limited surgical intervention, consisting of neurolysis, inguinal wall repair and/or adductor debridement of adhesions based on intraoperative findings. Retrospective case series. Outpatient orthopedic/general surgery clinic. Fifty-one athletes treated surgically for inguinal-related groin pain from 2009 to 2015. Limited surgical intervention, consisting of neurolysis, inguinal wall repair and/or adductor debridement based on intra-operative findings. Ability to return to sport at the same level, time to return to play. Fifty-one athletes were included in the study with an average follow-up of 4.42 years (range 2.02–7.01). The average age was 24.2 years (range 16–49) and consisted of 94.0% males and 6.0% females. Nerve entrapment was demonstrated in 96.2% of cases with involvement of the ilioinguinal in 92.5%, the iliohypogastric in 30.8% and the genitofemoral in 13.2%. Attenuation of the posterior inguinal wall was present and repaired in 79.3% of cases. Scar tissue was present around the adductor origin and required debridement in 56.7% of cases. Forty-nine (96.1%) athletes returned to sport at the same level of play at an average of 5.9 weeks. Two athletes required a revision surgery. High rates of return to sport were achieved after surgery for inguinal-related groin pain that addresses the varying pathology and associated nerve entrapment.

Successful Resolution of Chronic Testicular Pain With an Impairment-Based Treatment Program: A Case Study With One-Year Follow-Up

“…Potential causes include structural disorders (i.e. spermatocele, varicocele, trauma, epididymitis, and tumor), trauma, sports hernia, low back injury, post-vasectomy syndrome, prostatitis, pelvic floor dysfunction, and nerve entrapment [3,[5][6][7][8].…”

“…Genitofemoral and ilioinguinal nerve entrapment or injury is more common following herniorrhaphy [8]. Finally, physical compression of the nerve(s) may not be appreciated upon imaging, but instead, observed during surgical exploration [7]. There appear to be three different pathoanatomic mechanisms for genitofemoral, ilioinguinal, and/or iliohypogastric nerve entrapment.…”

“…First, an imbalance between the abdominal and hip adductor muscles results in a weakening of the posterior wall of the inguinal canal [ 9 ]. This may result in bulging of the abdominal structures, thereby compressing the genitofemoral and ilioinguinal nerves [ 7 , 9 ]. Second, there are congenital variations in the course of these nerves and tissue adhesions linked to previous inflammation, surgery, or other traumatic and metabolic conditions that may not allow the nerves to stretch when stressed during activity [ 7 ].…”

“…This may result in bulging of the abdominal structures, thereby compressing the genitofemoral and ilioinguinal nerves [ 7 , 9 ]. Second, there are congenital variations in the course of these nerves and tissue adhesions linked to previous inflammation, surgery, or other traumatic and metabolic conditions that may not allow the nerves to stretch when stressed during activity [ 7 ]. Finally, idiopathic entrapment may occur when the transverse abdominus or internal oblique muscles contract resulting in mechanical irritation of the ilioinguinal nerve due to its passage through those muscles [ 5 , 10 ].…”

“…The ilioinguinal nerve pierces both abdominal muscles prior to entering the inguinal canal [ 6 ]. In a study involving 51 athletes with groin pain recalcitrant to conservative measures, surgical exploration and neurolysis were performed [ 7 ]. Ninety-six percent of the patients demonstrated nerve entrapment, primarily the ilioinguinal nerve (92.5%) due to nerve adherence to surrounding soft tissue.…”