Sports related hernias are also called athletic pubalgia. It is associated with sudden, twisting movements and sharp changes in direction during vigorous sports activity. It is a different kind of injury though eventually it may lead to an abdominal hernia. A muscle, ligament or tendon or any soft tissue encounters a tear in the groin or the lower abdominal area. Several tissues are affected differentiating it from a traditional hernia and so is called athletic pubalgia by the medical community. Typical surgical repair requires the inguinal floor to be repaired with the placement of a no-tension mesh.
The oblique muscles in the lower abdomen are most affected due to their vulnerability. The weak tendons attach the pubic bone and the oblique muscles or the pubic bone and thigh muscles and are torn as they stretch. Other traditional hernias occur in the inguinal canal.
Symptoms and physical examination
The patient experiences excruciating pain in the groin area during injury. The pain improves with rest but returns with sporting activity. On physical examination, tenderness is palpable above the pubis ramus and in the groin. Tenderness is also noticed on the medial inguinal floor. Resisted hip abduction exacerbates the pain. Specific pain is also noted with a resisted sit-up at the inguinal floor.
Initial testing may involve flexing the patient???s trunk against resistance that will indicate pain. Imaging tests may include an MRI or x-ray for determination of a sports hernia. Bone tests may also be conducted to negate any other causes of pain. Radiologic aids help in identifying any chronic and unrelated conditions and subtle pathologies.
MRI can identify all adductor injuries. The following abnormalities can be noted on MRI:
- Adductor aponeurotic injury or lateral rectus abdominis ??? this injury is adjacent to the external inguinal ring
- Adductor aponeurotic plate injury or midline rectus abdominis
- Osteitis pubis
- Pubic marrow enhancement
A grade 4/5 and above score on medial inguinal tenderness will certainly require surgery. Surgery usually reveals a cord lipoma, an attenuated inguinal floor and disruption of the external oblique fascia.
Various small incisions are made for entry of the tubes near the herinal area. With a laparoscopic aid, the subcutaneous tissues are divided. Before approaching the inguinal floor, the external oblique is identified and carefully examined. A tear is extended where the external oblique fascia is already torn. The flaps are raised inferiorly and superiorly to expose the spermatic cord. This is then dissected free of the pubis. The spermatic cord is then looped with a penrose drain and freed to the level of the inguinal ring. The stretched out branches of the iliolinguinal or iliohypogastric nerves are ablated. A high ligation is performed to the indirect inguinal hernia if present. The floor of the inguinal canal is then exposed and reconstructed. The oblique fascia is also closed, completely closing the external inguinal ring. Absorbable sutures are used to close the subcutaneous fascia and the skin. Absorbable sutures are used to close the subcutaneous fascia and the skin.