Sports Hernia

Posterior Inguinal Wall Weakness ‘Sports hernia’:

  • Usually male football players who have a long history of gradually worsening, poorly localised pain aggravated by activity, especially kicking
  • These patients are often classified as having ‘inguinal insufficiency’, ‘footballer’s hernia’, ‘sportsman’s hernia’ and ‘Gilmores Groin’
  • This diagnosis is controversial as to its existence. If a patient presents with groin pain , please see the section on adductor strain or tendonopathy

Pathology:

It is thought that dilation of the external inguinal ring may be caused by a number of different pathologies, including :

  • A tear in the transversalis or external oblique aponeurosis. This may be due to an increase in intrabdominal pressure in sport
  • A tear in the conjoined tendon. This may be due to intense sporting activity, particularly kicking which places an increased downward pressure on the conjoined tendon and muscle fatigue.
  • A separation of the inguinal ligament from the conjoined tendon 
  • Tearing of the conjoined tendon from the pubic tubercle

Media

Sportsmen’s groin, a localized bulge in the posterior inguinal wall with compression of the genital

Sportsmen’s groin, a localized bulge in the posterior inguinal wall with compression of the genital branch of the genitofemoral nerve

 

Subjective History:

  • Usually an insidious onset of pain 
  • May present as an acute injury followed by chronic pain
  • Pain will usually will occur near the end or after activity 
  • As the condition progresses, the pain will worsen and start to occur earlier in the activity 
  • The pain is usually located in the posterior inguinal floor inside the external ring.
  • The patient may describe radiation of pain into the testicle, adductors or laterally in the upper thigh
  • Pain usually aggravated by sudden movement, sneezing, coughing, sexual activity or valsalva manoeuvre.
  • Symptoms will tend to ease with prolonged rest from sporting activity , but will usually return once high intensity activity is resumed.

Objective Examination:

  • Maximal tenderness is usually felt over the pubic tubercle 
  • The most helpful diagnostic sign is dilation and or discomfort to palpation of the external inguinal ring after invagination of the scrotum 
  • There is some evidence that ultrasound examination and MRI may be able to detect hernias

Treatment :

  • Controversial pathology . More likely a chronic groin injury (tendinopathy)
  • Surgery not offered on the NHS 
  • Please refer to adductor tendinopathy for management

 

References

  • Image from OpenI – Licensed by CC

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