Sports Hernia—History and Physical Examination: Making the Diagnosis with Confidence

Abstract

Sports hernia represents a complex clinical entity that is generally poorly understood and commonly missed by sports medicine clinicians. Patients are typically athletes involved in sports requiring explosive movements with rapid changes in direction, resulting in trunk hyperextension and thigh hyperabduction and resultant shear injury to the hemi-pelvis with pathologic weakening of the posterior inguinal canal. They present with chronic activity-related groin or lower quadrant abdominal pain that is relieved by rest but returns with sport. The discrete diagnosis of sports hernia has been historically difficult to make due to the fact that a number of other musculoskeletal, gastrointestinal, genitourinary, and systemic diagnoses can have a similar presentation. The pathoanatomy of sports hernia, therefore, does not fit perfectly into one medical subspecialty, making it difficult for a single provider to adequately evaluate a patient with activity-related groin pain. Clinicians require not only a high index of suspicion, but also a broad clinical skill set to be able to rule out the numerous other clinical mimickers, and rule in the diagnosis of sports hernia. The goal of this chapter is to assist the clinician in the distillation of what can be a tremendous amount of vague clinical data, into a focused constellation of history and physical exam findings, resulting in the confident diagnosis of this condition.