Sports Hernia
3 years ago
by John Read
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‘Sports hernia’ is a condition of chronic exercise-related supra-inguinal groin pain which is associated with an incipient direct bulge of the inguinal wall whenever the abdominal muscles contract forcefully. This limits athletic performance and can be a ‘career-ending’ injury.
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Symptoms
Sports that are most often affected involve kicking and/or rapid acceleration with an accompanying sudden change in direction (e.g. soccer, rugby, AFL, ice hockey, martial arts). The pain develops during exercise, is generally unilateral but occasionally bilateral, and is typically located in the supra-inguinal portion of lower abdomen lateral to rectus abdominis, sometimes radiating to the testis (Fig 1, solid arrows). Importantly, it does not reach the pelvic midline, but can often radiate into the medial thigh along the path of adductor longus (Fig 1, dotted arrows). Sports hernia pain is often aggravated by sudden acceleration, twisting and turning, cutting and kicking, coughing and/or sneezing, and sit-ups. The pain generally persists after a game, with accompanying stiffness and difficulty getting out of bed the following day. In most cases, the initial onset is insidious. However, in about one third of cases, the patient recalls a sudden ‘tearing’ sensation at the time of initial symptom onset [1]. Despite any period of rest or lay-off, Sports hernia pain returns immediately and with full force upon resumption of sport.
Physical findings
The overwhelming majority of patients are young adult males. Objective physical examination findings are typically sparse. A palpable cough impulse is either weak or absent. A subtle bulge in skin surface contour can occasionally be seen over the affected inguinal region when observed from above with the patient standing. Pain may be evoked with a resisted abdominal ‘crunch’ and tenderness elicited most commonly over the conjoint tendon immediately superomedial to pubic tubercle. Many patients also exhibit tenderness over the ipsilateral adductor longus origin and/or have a positive adductor ‘squeeze’ test in bent knee position (pain and inhibition when asked to squeeze the legs together against resistance).
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