Concept: Athletic pubalgia
Abdominal hernias are common with over 20 million hernia repairs performed worldwide. Inguinal hernias are the most common type of hernia. Inguinal and sports hernia have been discussed at length in recent literature, and therefore, they will not be addressed in this article. The noninguinal hernias are much less common but do occur, and knowledge of these hernias is important when assessing the athlete with abdominal pain. Approximately 25% of abdominal wall hernias are noninguinal, and new data show the order of frequency as umbilical, epigastric, incisional, femoral, and all others (i.e., Spigelian, obturator, traumatic). Return-to-play guidelines need to be tailored to the athlete and the needs of their sport. Using guidelines similar to abdominal strain injuries can be a starting point for the treatment plan. Laparoscopic repair is becoming more popular because of safety and efficacy, and it may lead to a more rapid return to play.
Athletic pubalgia is a complex injury that results in loss of play in competitive athletes, especially hockey players. The number of reported sports hernias has been increasing, and the importance of their management is vital. There are no studies reporting whether athletes can return to play at preinjury levels.
In their paper “Prevalence of Surgical Repair for Athletic Pubalgia and Impact on Performance in Football Athletes Participating in the National Football League Combine,” Knapik et al. cut through the baloney in the literature on “sports hernia” and apply new eyes to the impact of the results of core muscle surgery on young elite athletes trying out for the National Football League (NFL). They found that the players who had surgery did just as well as all the others in and following NFL Combines. Even the players with presumptively residual, MRI findings did well. The paper is superb and identifies, in subtle ways, the importance of magnetic resonance imaging, as well as the role of experience in diagnosing and handling these injuries. The paper is a case control series that extracts tremendous beneficial information for sports physicians, athletic trainers, management, agents, players, and all of us Sunday afternoon, TV-watching football experts.
Athletic Pubalgia, more commonly known as sports hernia, is defined as chronic lower abdominal and groin pain without the presence of a true hernia. It is increasingly recognized in athletes as a source of groin pain and is often associated with other pathology. A comprehensive approach to the physical exam and a strong understanding of hip and pelvic anatomy are critical in making the appropriate diagnosis. Various management options are available. We review the basic anatomy, patholophysiology, diagnostic approach and treatment of athletic pubalgia as well as discuss associated conditions such as femoroacetabular impingement. [Full article available at http://rimed.org/rimedicaljournal-2016-10.asp].
- Hernia : the journal of hernias and abdominal wall surgery
- Published over 4 years ago
Sports hernias, or athletic pubalgia, is common in athletes, and primarily involves injury to the fascia, muscles, and tendons of the inguinal region near their insertion onto the pubic bone. However, management varies widely, and rectus and adductor tenotomies have not been adequately described. The purpose of this manuscript is to demonstrate a suture repair and a rectus and adductor longus tenotomy technique for sports hernias.
Groin pain is a common entity in athletes involved in sports that require acute cutting, pivoting, or kicking such as soccer and ice hockey. Athletic pubalgia is increasingly recognized as a common cause of chronic groin and adductor pain in athletes. It is considered an overuse injury predisposing to disruption of the rectus tendon insertion to the pubis and weakness of the posterior inguinal wall without a clinically detectable hernia. These patients often require surgical therapy after failure of nonoperative measures. A variety of surgical options have been used, and most patients improve and return to high-level competition.
Athletes are particularly predisposed to injuries in the groin and pelvic region. Men in particular are predisposed to injuries like hernias in the inguinal region. The increased demands and training load on today’s athletes combined with individual factors may create the environment for these injuries. Five areas categorize the pain present from different pathological entities in this region: adductor-related, iliopsoas-related, inguinal-related, pubic-related, and hip-related groin pain. It has been extremely difficult in the past to accurately diagnose what has been previously labeled sports hernia, sportsman’s groin, or inguinal disruption. Therefore, this article describes the methods and procedures used for diagnostic ultrasound (US) and differentiation between these entities from one practice based on the most current research in musculoskeletal US.
Athletic pubalgia, or “sports hernia”, represents a constellation of pathologic conditions occurring at and around the pubic symphysis. These injuries are primarily seen in athletes or those involved in athletic activity. In this article, we review the sonographic appearance of the relevant complex anatomy, scanning technique for ultrasound evaluation of athletic pubalgia, and the sonographic appearances of associated pathologic conditions.
Femoroacetabular impingement (FAI) is a common debilitating condition that is associated with groin pain and limitation in young and active patients. Besides FAI, various disorders such as hernias, adductor tendinopathy, athletic pubalgia, lumbar spine affections, and others can cause similar symptoms.
To investigate the association between sports hernias and femoroacetabular impingement (FAI) in athletes.