Sports hernia

Abstract

Pubalgia is a general term used to describe severe groin and hip pain in the professional athlete. The etiology of this condition can range from adductor tendon injuries, to hip injuries, to abdominal wall injuries. One of the least understood and most perplexing problems is the sports hernia. This diagnosis should be considered in athletes who do not respond to conservative treatment of pubalgia. Only recently has this entity become a known cause of persistent groin pain in the athlete. Some surgeons still do not believe this condition exists. We evaluated 96 professional athletes who underwent surgery for sports hernias. Thirty patients (31%) had adductor pain associated with either lower abdominal or inguinal pain. There were 92 patients (96%) who returned to their preinjury levels of performance. One should not offer surgery unless the groin pain has been present for at least 3 months. The authors describe the laparoscopic preperitoneal approach to repair these injuries. With the proper method of diagnosis and the expertise of an experienced laparoscopic surgeon, the athlete can return to active participation in sports within 3 to 6 weeks after surgery.

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

“…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. 53,58,62 Symptoms are usually unilateral, although pain often starts unilateral and progresses to become bilateral.…”

“…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.…”

“…39,53,59,61,75,80 The pain is usually exacerbated by kicking, sprinting, sidestepping, cutting, and/or performing sit-ups. 22,39,40,80 Some patients may complain of referred pain along the adductor longus tendon(s) with forceful or resisted hip adduction, 22,58,66 and most report point tenderness over the superior-lateral pubis. 48,51 Occasionally, patients with athletic pubalgia report groin pain with sneezing and coughing, 22,40,48,51,80 and males may report testicular pain.…”

“…22,39,40,80 Some patients may complain of referred pain along the adductor longus tendon(s) with forceful or resisted hip adduction, 22,58,66 and most report point tenderness over the superior-lateral pubis. 48,51 Occasionally, patients with athletic pubalgia report groin pain with sneezing and coughing, 22,40,48,51,80 and males may report testicular pain. 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.…”

“…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.…”