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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

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 :