Elsevier

Advances in Surgery

Volume 41, 2007, Pages 177-187
Advances in Surgery

Sports Hernias

https://doi.org/10.1016/j.yasu.2007.05.011Get rights and content

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History

Sports hernias, otherwise known as “sportsman's groin,” “Gilmore's groin,” “athletic pubalgia,” or “groin disruption,” were first described in 1980 by Gilmore [1] when three professional soccer players presented with unclear groin pain not responsive to medical management. These patients underwent exploratory surgery and surgical repair of the posterior inguinal wall. After repair, all three athletes were able to return to professional sports. In 1991, Taylor and colleagues [2] furthered the

Epidemiology

The true incidence of sports hernias is unknown; some authors believe that it occurs only rarely, and others believe that is the most common cause of chronic groin pain in athletes [7], [8], [9]. The estimation is made more difficult by the lack of a uniform definition. In Europe, the prevalence has been estimated to be between 5% and 28% in soccer players [2], [10]. Sports hernias are diagnosed most frequently in men. This increased frequency of sports hernias in men is most likely

Pathophysiology

A lack of uniform definition for sports hernias has led to confusion concerning the pathophysiology and thus treatment of this condition. Initially, some authors speculated that the cause was occult hernia, but further study of the presentation, operative findings, and success of repair suggest that it is not a hernia but a weakness in or injury to the pelvic floor caused by the weak flexion of the abdomen and the strong adduction of the hip.

The pelvis is a dynamic structure consisting of the

Signs and symptoms

A thorough history and physical examination are necessary to distinguish patients who have sports hernias from those patients who have other pathology. Sports hernias usually occur in high-performance athletes. Symptoms often are vague and gradual in onset, making diagnosis difficult. Some patients describe an immediate tearing, popping, or ripping pain at the time of injury, whereas others describe an increasing discomfort over 1 to 6 months [19]. Symptoms include chronic intermittent lower

Diagnosis

Diagnosis of a sports hernia requires a high index of suspicion. Factors that should increase a surgeon's suspicion are the complaint in a high-performance athlete, chronic pain with pubic tubercle pain, adductor pain/weakness, and a dilated internal ring. Plain-film radiographs and bone scans often are taken initially to rule out other pathology including fracture and/or pelvic instability. MRI and high-speed ultrasound can be helpful in further evaluating groin pain [27], [28]. High-speed

Treatment

Successful treatment of sports hernias depends on accurate diagnosis, meticulous repair, and intensive rehabilitation.

Summary

Sportsman's hernia is an increasingly recognized cause of chronic groin pain in athletes. Although the definition is controversial, it is a condition of chronic inguinal/pubic exertional pain caused by rectus abdominal wall weakness or injury without a palpable hernia, usually affecting high-performance male athletes. Diagnosis is made after careful history and physical examination. Some radiographic studies such as ultrasound or MRI may be helpful in evaluating these patients and ruling out

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      The reported cause of a sports hernia varies in the literature, from an actual inguinal hernia [38], a dilated superficial inguinal ring [39], a deficient posterior inguinal canal wall [40], the presence of a lipoma of the cord, to the absence of a hernia [41]. Others believe rectus abdominus insertion injury at the pubis is the cause of a sports hernia [42]. It is possible that different types of athletes may have different causes for what is clinically described as a sports hernia.

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