The sportsman's hernia ‐ fact or fiction?

Abstract

This review is based on the results of 308 operations for unexplained, chronic groin pain suspected to be caused by an imminent, but not demonstrable, inguinal hernia: the 'sportsman's hernia' (SH). No differences in perioperative findings between cured and non-cured athletes were found. However, there was a remarkable difference between the various perioperative findings in the studies. It was characteristic that further clinical investigation of the noncured, operated athletes gave an alternative and treatable diagnosis in more than 80% of cases. Herniography was used consistently in the diagnostic process in all the studies on SH. However, in 49% of cases hernias were also demonstrated on the opposite, asymptomatic groin side. In conclusion, the final diagnosis (and treatment) often reflects the speciality of the doctor and the present literature does not supply proper evidence to the theory that SH con-1 stitutes a credible explanation for chronic groin pain.Groin pain is a common problem among athletes in general and among soccer players in particular. Diagnoses to be considered in cases of groin pain include tendinitis or partial rupture of groin muscles or tendons (the adductor groups, m. rectus femoris, m. rectus abdominous, the hamstring group, m. sartorius and m. iliopsoas), bursitis (the iliopectineal bursa), periostitis, symphysitis, stress fracture (the ramus pubis suphf), avulsion (trochanter minor), neuralgia (the n. ilioinguinalis), diseases of the columna and the sacroiliac joints, adenitis, prostatitis, projecting abdominal pain and hernias.Palpable hernias are often asymptomatic, but have been reported to cause chronic groin pain (1, 2). It has recently been recommended by several abdominal surgeons that routine inguinal hernia repair in athletes with chronic groin pain, and in cases where no hernia is found by physical examination, should be performed. This recommendation is based on the condition termed 'the sportsman's hernia' (SH).We have conducted a review of the available literature in order to present and discuss the scientific basis for SH, for which an increasing number of athletes have received and currently are receiving surgical treatment. Literature reviewThe review was based on the results reported in six articles on SH. The number of operations for SH, the perioperative findings, and the follow-up periods are shown in Table l .A total of 323 surgical inguinal hernia repairs were performed in 295 athletes. At least 39 athletes (1 3%) had bilateral symptoms and 29 athletes (10%) were operated on bilaterally. Bilateral groin pain was found in 8% (3), 13% (4), 21% (5) and 32% (6) of the total numbers of athletes operated.In 15 cases there was clinical evidence of an inguinal hernia evaluated by palpation pre-operatively. In the remaining 308 cases the pre-operative examination was normal. The indication for these 308 operations was unexplained chronic groin pain suspected to be caused by an imminent, but not demonstrable, inguinal hernia -'the sportsman's hernia'.Polglase et al. oper...

Do MRI and ultrasound of the anterior pelvis correlate with, or predict, young football players’ clinical findings? A 4-year prospective study of elite academy soccer players

“…All of these structures have been suggested as potential sites of failure in groin pain in athletes, and since, it is also believed that multiple structures are commonly affected, clinical sensitivity is further decreased 2 4. Some authors believe inguinal aponeurotic injury initiates the process leading to symphyseal, rectus abdominis and adductor change developing later while others believe the process occurs in reverse 5–7…”

Sports hernias: a systematic literature review

“…Geographical and sports-specific differences seem to exist for the overdiagnosis or underdiagnosis of a sports hernia, with European soccer players with chronic groin pain more often diagnosed with a sports hernia and Australian Rules Football players with chronic with chronic groin pain more often diagnosed with osteitis pubis 22 24 – 26. Fredberg et al 27 suggested that proper evidence does not exist for the theory that a sports hernia constitutes a credible explanation for chronic groin pain, calling for greater restraint before surgical intervention.…”

Adductor-Related Groin Pain in Recreational Athletes

“…Our definitions of the three extra-articular causes of athletic groin pain are (1) adductor dysfunction, which is considered to be present if the physical examination demonstrates tenderness at the adductor enthesis as well as pain on passive adductor stretching and on resisted adduction; (2) osteitis pubis, which is inflammation of the pubic symphysis manifesting as a tender symphysis and which can be identified on magnetic resonance imaging; and (3) sports hernia, which is a clinical diagnosis confirmed at surgery and consists of any combination of a torn external oblique aponeurosis, a torn conjoined tendon, and dehiscence between the conjoined tendon and the inguinal ligament [1][2][3][4] (Table I).…”