Athletic pubalgia

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Athletic pubalgia
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Athletic pubalgia, also called sports hernia, [1] core injury, [2] hockey hernia, [3] hockey groin, [1] Gilmore's groin, [1] or groin disruption, [4] is a medical condition of the pubic joint affecting athletes. [5]

Contents

It is a syndrome characterized by chronic groin pain in athletes and a dilated superficial ring of the inguinal canal. Football and ice hockey players are affected most frequently. Both recreational and professional athletes may be affected.

Presentation

Symptoms include pain during sports movements, particularly hip extension, and twisting and turning. This pain usually radiates to the adductor muscle region and even the testicles, although it is often difficult for the patient to pin-point the exact location.

Following sporting activity the person with athletic pubalgia will be stiff and sore. The day after a match, getting out of bed or a car will be difficult. Any exertion that increases intra-abdominal pressure, such as coughing, sneezing, or sporting activity can cause pain. In the early stages, the person may be able to continue playing their sport, but the problem usually gets progressively worse.

As pain in the groin and pelvis can be referred from a number of problems, including injuries to the lumbar spine, the hip joint, the sacro-iliac joint, the abdomen, and the genito-urinary system, diagnosis of athletic pubalgia requires skillful differentiation and pubic examination in certain cases where there is intense groin pain.

Diagnosis

The diagnosis is based on the patient's history, clinical signs, and, increasingly, an MRI exam. [6] Symptoms can often be reproduced by maneuvers such as performing sit-ups or crunches. Pain can also be elicited with the patient in a "frog position", in which the patient is supine with knees bent and heels together. [7]

The exact lesion may differ, but common pathologic findings at operation are:

Several of these lesions may occur simultaneously. Also, many athletes have concomitant weakness or tearing of the adductor muscles or labral tears of the hip. When the adductor muscles are tight post injury, that can be enough to trigger symptoms.

Treatment

Conservative therapies (gentle stretching and a short period of rest [10] ) may temporarily alleviate the pain, but definitive treatment consists of surgical repair followed by a structured rehabilitation. [9] [11] The first conservative treatment option should be to restore normal motion after the adductor has begun to heal (usually 6–8 weeks post injury). Sleeping in a prone position with the hip on the affected side flexed and externally rotated can be a cure in some individuals. [12]

Incidence

The exact incidence of these entities is unknown: some believe it is the most common cause of chronic groin pain in athletes, while others argue that it is only rare. [13]

Related Research Articles

<span class="mw-page-title-main">Human leg</span> Lower extremity or limb of the human body (foot, lower leg, thigh and hip)

The human leg is the entire lower limb of the human body, including the foot, thigh or sometimes even the hip or buttock region. The major bones of the leg are the femur, tibia, and adjacent fibula. The thigh is between the hip and knee, while the calf (rear) and shin (front) are between the knee and foot.

<span class="mw-page-title-main">Hernia</span> Abnormal exit of tissues or organs from the cavity they usually reside in

A hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. Various types of hernias can occur, most commonly involving the abdomen, and specifically the groin. Groin hernias are most commonly of the inguinal type but may also be femoral. Other types of hernias include hiatus, incisional, and umbilical hernias. Symptoms are present in about 66% of people with groin hernias. This may include pain or discomfort in the lower abdomen, especially with coughing, exercise, or urinating or defecating. Often, it gets worse throughout the day and improves when lying down. A bulge may appear at the site of hernia, that becomes larger when bending down. Groin hernias occur more often on the right than left side. The main concern is bowel strangulation, where the blood supply to part of the bowel is blocked. This usually produces severe pain and tenderness in the area. Hiatus, or hiatal hernias often result in heartburn but may also cause chest pain or pain while eating.

<span class="mw-page-title-main">Inguinal hernia</span> Medical condition in which contents of the abdominal cavity protrude through the inguinal canal

An inguinal hernia or groin hernia, is a hernia (protrusion) of abdominal cavity contents through the inguinal canal. Symptoms, which may include pain or discomfort especially with or following coughing, exercise, or bowel movements, are absent in about a third of patients. Symptoms often get worse throughout the day and improve when lying down. A bulging area may occur that becomes larger when bearing down. Inguinal hernias occur more often on the right than left side. The main concern is strangulation, where the blood supply to part of the intestine is blocked. This usually produces severe pain and tenderness of the area.

<span class="mw-page-title-main">Groin</span> The two creases at the junction of the torso with the thighs, on either side of the pubic area

In human anatomy, the groin also known as the inguinal region or iliac region, is the junctional area between the torso and the thigh. The groin is at the front of the body on either side of the pubic tubercle, where the lower part of the abdominal wall meets the thigh. A fold or crease is formed at this junction known as the inguinal groove, or crease. This is also the area of the medial compartment of the thigh that contains attachments of the adductor muscles of the hip or the groin muscles. The groin is the common site for a hernia.

<span class="mw-page-title-main">Symphysis</span> Fibrocartilaginous fusion between two bones

A symphysis is a fibrocartilaginous fusion between two bones. It is a type of cartilaginous joint, specifically a secondary cartilaginous joint.

  1. A symphysis is an amphiarthrosis, a slightly movable joint.
  2. A growing together of parts or structures.
<span class="mw-page-title-main">Patellar tendinitis</span> Human disease

Patellar tendinitis, also known as jumper's knee, is an overuse injury of the tendon that straightens the knee. Symptoms include pain in the front of the knee. Typically the pain and tenderness is at the lower part of the kneecap, though the upper part may also be affected. Generally there is no pain when the person is at rest. Complications may include patellar tendon rupture.

<span class="mw-page-title-main">Osteitis pubis</span> Medical condition

Osteitis pubis is a noninfectious inflammation of the pubis symphysis, causing varying degrees of lower abdominal and pelvic pain. Osteitis pubis was first described in patients who had undergone suprapubic surgery, and it remains a well-known complication of invasive procedures about the pelvis. It may also occur as an inflammatory process in athletes. The incidence and cause of osteitis pubis as an inflammatory process versus an infectious process continues to fuel debate among physicians when confronted by a patient who presents complaining of abdominal pain or pelvic pain and overlapping symptoms. It was first described in 1924.

Meralgia paresthetica or meralgia paraesthetica is numbness or pain in the outer thigh not caused by injury to the thigh, but by injury to a nerve that extends from the spinal column to the thigh.

<span class="mw-page-title-main">Iliopsoas</span> Joined psoas and the iliacus muscles.

The iliopsoas muscle refers to the joined psoas major and the iliacus muscles. The two muscles are separate in the abdomen, but usually merge in the thigh. They are usually given the common name iliopsoas. The iliopsoas muscle joins to the femur at the lesser trochanter. It acts as the strongest flexor of the hip.

<span class="mw-page-title-main">Abdomen</span> Part of the body between the chest and pelvis

The abdomen is the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the front part of the abdominal segment of the torso. The area occupied by the abdomen is called the abdominal cavity. In arthropods it is the posterior tagma of the body; it follows the thorax or cephalothorax.

<span class="mw-page-title-main">Snapping hip syndrome</span> Medical condition

Snapping hip syndrome, also referred to as dancer's hip, is a medical condition characterized by a snapping sensation felt when the hip is flexed and extended. This may be accompanied by a snapping or popping noise and pain or discomfort. Pain often decreases with rest and diminished activity. Snapping hip syndrome is commonly classified by the location of the snapping as either extra-articular or intra-articular.

<span class="mw-page-title-main">Conjoint tendon</span> Medial part of the posterior wall of the inguinal canal

The conjoint tendon is a sheath of connective tissue formed from the lower part of the common aponeurosis of the abdominal internal oblique muscle and the transversus abdominis muscle, joining the muscle to the pelvis. It forms the medial part of the posterior wall of the inguinal canal.

In human anatomy, the inguinal region refers to either the groin or the lower lateral regions of the abdomen. It may also refer to:

Femoral hernias occur just below the inguinal ligament, when abdominal contents pass through a naturally occurring weakness in the abdominal wall called the femoral canal. Femoral hernias are a relatively uncommon type, accounting for only 3% of all hernias. While femoral hernias can occur in both males and females, almost all develop in women due to the increased width of the female pelvis. Femoral hernias are more common in adults than in children. Those that do occur in children are more likely to be associated with a connective tissue disorder or with conditions that increase intra-abdominal pressure. Seventy percent of pediatric cases of femoral hernias occur in infants under the age of one.

<span class="mw-page-title-main">Iliopubic tract</span>

The iliopubic tract is a thickened band of fibers curving over the external iliac vessels, at the spot where they become femoral, on the abdominal side of the inguinal ligaments and loosely connected with it. It is apparently a thickening of the transversalis fascia joined laterally to the iliac crest, and arching across the front of the femoral sheath to be inserted by a broad attachment into the pubic tubercle and pectineal line, behind the conjoint tendon. In some subjects this structure is not very prominently marked, and not infrequently it is altogether wanting. It can be of clinical significance in hernia repair.

<span class="mw-page-title-main">Unhappy triad</span> Medical condition of the knee

The unhappy triad, also known as a blown knee among other names, is an injury to the anterior cruciate ligament, medial collateral ligament, and meniscus. Analysis during the 1990s indicated that this 'classic' O'Donoghue triad is actually an unusual clinical entity among athletes with knee injuries. Some authors mistakenly believe that in this type of injury, "combined anterior cruciate and medial collateral ligament disruptions that were incurred during athletic endeavors" always present with concomitant medial meniscus injury. However, the 1990 analysis showed that lateral meniscus tears are more common than medial meniscus tears in conjunction with sprains of the ACL.

<span class="mw-page-title-main">Obturator hernia</span> Medical condition

An obturator hernia is a rare type of hernia, encompassing 0.07-1% of all hernias, of the pelvic floor in which pelvic or abdominal contents protrudes through the obturator foramen. The obturator foramen is formed by a branch of the ischial as well as the pubic bone. The canal is typically 2-3 centimeters long and 1 centimeters wide, creating a space for pouches of pre-peritoneal fat.

In medicine, Carnett's sign is a finding on clinical examination in which (acute) abdominal pain remains unchanged or increases when the muscles of the abdominal wall are tensed. For this part of the abdominal examination, the patient can be asked to lift the head and shoulders from the examination table to tense the abdominal muscles. An alternative is to ask the patient to raise both legs with straight knees.

Round ligament pain (RLP) is pain associated with the round ligament of the uterus, usually during pregnancy. RLP is one of the most common discomforts of pregnancy and usually starts at the second trimester of gestation and continues until delivery. It usually resolves completely after delivery although cases of postpartum RLP have been reported. RLP also occurs in nonpregnant women.

<span class="mw-page-title-main">Inguinal hernia surgery</span> Medical procedure

Inguinal hernia surgery is an operation to repair a weakness in the abdominal wall that abnormally allows abdominal contents to slip into a narrow tube called the inguinal canal in the groin region.

References

  1. 1 2 3 Meyers, William C.; Yoo, Edward; Devon, Octavia N.; Jain, Nikhil; Horner, Marcia; Lauencin, Cato; Zoga, Adam (October 2007). "Understanding "Sports Hernia" (Athletic Pubalgia): The Anatomic and Pathophysiologic Basis for Abdominal and Groin Pain in Athletes". Operative Techniques in Sports Medicine. 15 (4): 165–177. doi:10.1053/j.otsm.2007.09.001. ISSN   1060-1872.
  2. ↑ Ross, James R.; Stone, Rebecca M.; Larson, Christopher M. (December 2015). "Core Muscle Injury/Sports Hernia/Athletic Pubalgia, and Femoroacetabular Impingement". Sports Medicine and Arthroscopy Review. 23 (4): 213–220. doi:10.1097/JSA.0000000000000083. PMID   26524557. S2CID   11850885.
  3. ↑ Omar IM, Zoga AC, Kavanagh EC, et al. (2008). "Athletic pubalgia and "sports hernia": optimal MR imaging technique and findings". Radiographics. 28 (5): 1415–38. doi:10.1148/rg.285075217. PMID   18794316.
  4. ↑ "Gimore's Groin, Symptoms, Diagnosis, Treatment" (PDF). thegilmoregroinandherniaclinic.co.uk. 2013. Archived from the original (PDF) on 2013-12-03. Retrieved April 30, 2013.
  5. ↑ Ahumada LA, Ashruf S, Espinosa-de-los-Monteros A, Long JN, de la Torre JI, Garth WP, Vasconez LO (2005). "Athletic pubalgia: definition and surgical treatment". Ann Plast Surg. 55 (4): 393–6. doi:10.1097/01.sap.0000181344.22386.fa. PMID   16186706. S2CID   24007081.
  6. ↑ "Sports Hernia". Orthopedics.about.com. 2005-12-16. Retrieved 2011-11-13.
  7. ↑ Le Blanc, E; LeBlanc KA (2003). "Groin pain in athletes". Hernia. 7 (2): 68–71. doi:10.1007/s10029-002-0105-x. PMID   12820026. S2CID   24609449.
  8. ↑ Joesting DR (2002). "Diagnosis and treatment of sportsman's hernia". Curr Sports Med Rep. 1 (2): 121–4. doi:10.1249/00149619-200204000-00010. PMID   12831721.
  9. 1 2 sports/162 at eMedicine
  10. ↑ "athletic pubalgia" . GPnotebook.
  11. ↑ "The Gilmore Groin & Hernia Clinic Archived 2007-07-06 at the Wayback Machine ". Retrieved November 24, 2006.
  12. ↑ "Positions to Sleep in for Lower Back Pain – Which One is Right for You?". 26 March 2022. Retrieved 28 June 2022.
  13. ↑ Fredberg U, Kissmeyer-Nielsen P (1996). "The sportsman's hernia—fact or fiction?". Scand J Med Sci Sports. 6 (4): 201–4. doi:10.1111/j.1600-0838.1996.tb00091.x. PMID   8896091.
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