Sports Hernia

 

A sports hernia (also known as athletic pubalgia, sportsman's hernia or Gilmore's groin) is not a true hernia but a tear or disruption of the muscles and tendons in the groin and is thought to involve injuries to the abdominal wall and pelvic musculature which causes a weakness of the posterior wall of the inguinal canal.  It typically occurs in athletes, hence the name Sports hernia.  The injury is relatively common in athletes who participate in those sports that involve twisting movements or sports which place strain on the groin such as football.  It is much more common in men compared to women with females comprising just 3-15% of all sports hernia referrals

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Exclude red flag symptoms

Unless there are palpable firm masses within the region, which may represent lymph nodes, there are no red flags in the presentation of a sports hernia

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Signs and symptoms

However, those with the condition typically complain of some or all of the following symptoms:

  • Pain in the groin that is brought on by exertion such as running, sprinting, twisting and turning
  • Pain may not come on until 10-20 minutes of activity
  • Patients often complain of unilateral or bilateral groin pain (difficult to localize but described as being above the inguinal ligament). Pain can radiate to the scrotum and inner thigh and cross the midline
  • Exercise may be followed by stiffness and soreness which may persist into the following day
  • Following exercise, getting out of bed or a car may cause pain and discomfort
  • Some may notice that coughing and sneezing also causes discomfort and pain in the groin
  • Symptoms may start suddenly. However, most athletes feel that the discomfort comes on gradually

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Examination

When suspecting sports hernia, look out for the following:

  • Tenderness over the pubic symphysis and/or pubic tubercle
  • Tenderness over the superficial ring on palpation (a 1/3 of the distance along a line drawn from the pubic tubercle to the anterior superior iliac spine)
  • Increased pain with palpation over the superficial ring when the patient performs a straight leg raise
  • Pain on resisted sit ups

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NOTE:  Adductor weakness is also present in 40% of cases

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Investigations

Other pathologies and a true hernia can be excluded with an USS or a MRI

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Conservative management

Non-operative management:

  1. This should be attempted for a period of 6 to 12 weeks and should include rest from the aggravating activity, physiotherapy and NSAIDS. Return to sport should be in a careful, graduated manner
  2. If this fails then operative intervention should be considered

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Surgical Intervention

NOTE:  Before surgery it is likely that specialised investigations are performed in order to exclude other causes of groin pain

This aim is to reinforce the posterior abdominal wall which forms the posterior border of the inguinal canal. Techniques are based on variations of standard hernia repairs and use of mesh to reinforce

These procedures can be performed by either open or laparoscopic approaches

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Post-op outcomes

Successful surgery is dependent upon accurate diagnosis, meticulous repair and adherence to a strict post-operative rehabilitation program

Surgery has a high success rate and most patients can return to their previous level of activity after a 4 to 6 week period of rehabilitation

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Referral information

Information to include in referral letter:

  • Evidence that the 6 to 12 weeks of non-operative management has been completed and that this has failed to improve the situation
  • Relevant past medical/surgical history
  • Current regular medication
  • BMI/Smoking Status

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Ultrasound

For ultrasonography investigations you refer a patient to one of the following acute or community ultrasound providers

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Radiology

For MRI scans, you can refer the patient to the Radiology Department at East Kent Hospitals (find details here)

Advice and Guidance is being made available for all specialties, and is being provided by consultant specialists at East Kent Hospitals.  To make a request or to check to if a query has been answered, you will need to log in via the electronic Referral System (eRS)

Click here for the "how to access" e-Referral Advice and Guidance Manual for instructions on how to make a request and check responses

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