Skip to main content
SpringerLink
Log in

Management of Abdominal Wall Hernias, Sports Hernias, and Athletic Pubalgia

  • Chapter
  • First Online:
Management of Abdominal Hernias

  • 1783 Accesses

Abstract

Groin injuries are a common occurrence in sport, especially in elite-level athletes. Most of these injuries are muscular strains that resolve completely with standard conservative management measures. However, some groin injuries result in a significant loss of playing time and can be a source of persistent pain that limits performance. Over the last 20 years, a subset of athletes with chronic, unremitting groin pain known commonly as “sports hernia” has become increasingly recognized. These injuries present challenging diagnostic and therapeutic management problems for athletic trainers and physicians because of the broad range of diagnostic possibilities, the subtle physical exam findings, and the anatomic complexity of the lower abdominal and groin region. In this chapter, the clinical presentation, diagnostic evaluation, and treatment options for athletes with a possible sports hernia will be reviewed. The differential diagnosis of athletic groin pain will also be discussed since surgeons who treat these athletes must understand the spectrum of injuries in order to make an accurate diagnosis.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Renstrom P, Peterson L. Groin injuries in athletes. Br J Sports Med. 1980;14:30–6.

    Article  CAS  Google Scholar 

  2. Ekstrand J, Hilding J. The incidence and differential diagnosis of acute groin injuries in male soccer players. Scand J Med Sci Sports. 1999;9:98–103.

    Article  CAS  Google Scholar 

  3. Smodlaka VN. Groin pain in soccer players. Phys Sports Med. 1980;8:57–61.

    Article  CAS  Google Scholar 

  4. Pettersson R, Lorenzton R. Ice hockey injuries: a 4 year prospective study of a Swedish elite ice hockey team. Br J Sports Med. 1993;27:251–4.

    Article  CAS  Google Scholar 

  5. Stuart MJ, Smith A. Injuries in junior a ice hockey: a 3 year prospective study. Am J Sports Med. 1995;23:458–61.

    Article  CAS  Google Scholar 

  6. Lorentzen R, Wedren H, Pietila T. Incidences, nature, and causes of ice hockey injuries: a three year prospective study of a Swedish elite ice hockey team. Am J Sports Med. 1988;16:392–296.

    Article  Google Scholar 

  7. Molsa J, Airaksinen O, Nasman O, et al. Ice hockey injuries in Finland: a prospective epidemiologic study. Clin J Sports Med. 1997;9:151–6.

    Google Scholar 

  8. de Sa D, Holmich P, Phillips M, Heaven S, Simunovic N, Philippon MJ, et al. Athletic groin pain: a systematic review of surgical diagnoses, investigations and treatment. Br J Sports Med. 2016;50(19):1181–6.

    Article  Google Scholar 

  9. Choi HR, Elattar O, Dills VD, Busconi B. Return to play after sports hernia surgery. Clin Sports Med. 2016;35(4):621–36.

    Article  Google Scholar 

  10. Emery CA, Meeuwisse WH, Powell J. Groin and abdominal injuries in the National Hockey League. Clin J Sports Med. 1999;9(9):151–6.

    Article  CAS  Google Scholar 

  11. Emery CA, Meeuwisse WH. Risk factors for groin injuries in hockey. Med Sci Sports Exerc. 2001;33:1423–33.

    Article  CAS  Google Scholar 

  12. Tyler TF, Nicholas SJ, Campbell RJ, McHugh MP. The association of hip strength and flexibility with the incidence of adductor muscle strains in professional ice hockey players. Am J Sports Med. 2001;29:124–8.

    Article  CAS  Google Scholar 

  13. Lacroix VJ. A complete approach to groin pain. Phys Sports Med. 2000;28:66–86.

    Article  CAS  Google Scholar 

  14. Anderson K, Strickland AM, Warren R. Hip and groin injuries in athletes. Am J Sports Med. 2001;29:521–33.

    Article  CAS  Google Scholar 

  15. Swan KGJ, Wolcott M. The athletic hernia. Clin Ortho Rel Res. 2006;455:78–87.

    Article  Google Scholar 

  16. Nam A, Brody F. Management and therapy for sports hernia. J Am Coll Surg. 2008;206:154–64.

    Article  Google Scholar 

  17. Caudill P, Nyland J, Smith C, Jerasimides Y, Lach J. Sports hernias: a systematic literature review. Br J Sp Med. 2008;42:954–64.

    Article  CAS  Google Scholar 

  18. King E, Ward J, Small L, Falvey E, Franklyn-Miller A. Athletic groin pain: a systematic review and meta-analysis of surgical versus physical therapy rehabilitation outcomes. Br J Sports Med. 2015;49(22):1447–51.

    Article  CAS  Google Scholar 

  19. Jansen JA, Mens JM, Backx FJ, Kolfschoten N, Stam HJ. Treatment of longstanding groin pain in athletes: a systematic review. Scand J Med Sci Sports. 2008;18(3):263–74.

    Article  CAS  Google Scholar 

  20. Fricker P, Taunton J, Ammann W. Osteitis pubis in athletes: infection, inflammation, or injury. Sports Med. 1991;12:266–79.

    Article  CAS  Google Scholar 

  21. Schlegel TF, Bushnell BD, Godfrey J, Boublik M. Success of nonoperative management of adductor longus tendon ruptures in National Football League athletes. Am J Sports Med. 2009;37:1394–9.

    Article  Google Scholar 

  22. Ekstrand J, Ringbog S. Surgery versus conservative treatment in soccer players with chronic groin pain: a prospective, randomized study in soccer players. Eur J Sports Traumatol Rel Res. 2001;23:141–5.

    Google Scholar 

  23. Paajanen H, Brinck T, Hermunen H, Airo I. Laparoscopic surgery for chronic groin pain in athletes is more effective than nonoperative treatment: a randomized clinical trial with magnetic resonance imaging of 60 patients with sportsman’s hernia (athletic pubalgia). Surgery. 2011;150(1):99–107.

    Article  Google Scholar 

  24. Meyers W, Foley D, Garrett W, Lohnes J, Mandelbaum B. Management of severe lower abdominal or inguinal pain in high-performance athletes. Am J Sports Med. 2000;28:2–8.

    Article  CAS  Google Scholar 

  25. Hemingway AE, Herrington L, Blower AL. Changes in muscle strength and pain in response to surgical repair of posterior abdominal wall disruption followed by rehabilitation. Br J Sports Med. 2003;37:54–8.

    Article  CAS  Google Scholar 

  26. Steele P, Annear P, Grove JR. Surgery for posterior inguinal wall deficiency in athletes. J Sci Med Sport. 2004;7:415–21.

    Article  CAS  Google Scholar 

  27. Gilmore OJA. Gilmomre’s groin: ten years experience of groin disruption – a previously unsolved problem in sportsmen. Sports Med Soft Tissue Trauma. 1991;3:12–4.

    Google Scholar 

  28. Gilmore OJA. Gilmore’s groin. Sports Med Soft Tissue Trauma. 1992;3:3.

    Google Scholar 

  29. Irshad K, Feldman L, Lavoie C, Lacroix V, Mulder D, Brown R. Operative management of “hockey groin syndrome”: 12 years experience in National Hockey League players. Surgery. 2001;130:759–66.

    Article  CAS  Google Scholar 

  30. Sheen AJ, Stephenson BM, Lloyd DM, Robinson P, Fevre D, Paajanen H, et al. ‘Treatment of the sportsman’s groin’: British hernia Society’s 2014 position statement based on the Manchester consensus conference. Br J Sports Med. 2014;48(14):1079–87.

    Article  Google Scholar 

  31. Weir A, Brukner P, Delahunt E, Ekstrand J, Griffin D, Khan KM, et al. Doha agreement meeting on terminology and definitions in groin pain in athletes. Br J Sports Med. 2015;49(12):768–74.

    Article  Google Scholar 

  32. Serner A, van Eijck CH, Beumer BR, Holmich P, Weir A, de Vos RJ. Study quality on groin injury management remains low: a systematic review on treatment of groin pain in athletes. Br J Sports Med. 2015;49(12):813.

    Article  Google Scholar 

  33. Meyers WC, McKechnie A, Philippon MJ, Horner MA, Zoga AC, Devon ON. Experience with “sports hernia” spanning two decades. Ann Surg. 2008;248:656–65.

    PubMed  Google Scholar 

  34. Brunt LM, Quasebarth MA, Bradshaw J, Barile R. Outcomes of a standardized approach to surgical repair and postoperative rehabilitation of athletic hernia. AOSSM Annual Meeting: Calgary; 2007.

    Google Scholar 

  35. Zoga AC, Kavanagh EC, Meyers WC, et al. MRI findings in athletic pubalgia and the “sports hernia”. Radiology. 2008;247:797–807.

    Article  Google Scholar 

  36. Omar IM, Zoga A, Kavanagh EC, Koulouris G, Bergin D, Gopez AG, et al. Athletic pubalgia and “sports hernia”: optimal MR imaging technique and findings. Radiographics. 2008;28:1415–38.

    Article  Google Scholar 

  37. Orchard JW, Read JW, Neophyton J, Garlick D. Groin pain associated with ultrasound finding of inguinal canal posterior wall deficiency in Australian rules footballers. Br J Sports Med. 1998;32:134–9.

    Article  CAS  Google Scholar 

  38. Muschawek U, Berger L. Minimal repair technique of sportsmen’s groin: an innovative open-suture repair to treat chronic groin pain. Hernia. 2010;14:27–33.

    Article  Google Scholar 

  39. Meyers WC, Greenleaf R, Saad A. Anatomic basis for evaluation of abdominal and groin pain in athletes. Oper Tech Sports Med. 2005;13:55–61.

    Article  Google Scholar 

  40. Meyers WC, Yoo E, Devon ON, Jain N, Horner M, Lauencin C, et al. Understanding “sports hernia” (athletic pubalgia): the anatomic and pathophysiologic basis for abdominal and groin pain in athletes. Oper Tech Sports Med. 2007;15:165–77.

    Article  Google Scholar 

  41. Biedert RM, Warnke K, Meyer S. Symphysis syndrome in athletes: surgical treatment for chronic lower abdominal, groin, and adductor pain in athletes. Clin J Sports Med. 2003;13:278–84.

    Article  Google Scholar 

  42. Farber AJ, Wilckens JH. Sports hernia: diagnosis and therapeutic approach. J Am Acad Orthop Surg. 2007;15:507–14.

    Article  Google Scholar 

  43. Muschawek U, Berger LM. Sportsmen’s groin – diagnostic approach and treatment with the minimal repair technique. Sports Health. 2010;2:216–21.

    Article  Google Scholar 

  44. Brown R, Mascia A, Kinnear DG, Lacroix VJ, Feldman L, Mulder DS. An 18 year review of sports groin injuries in the elite hockey player: clinical presentation, new diagnostic imaging, treatment, and results. Clin J Sports Med. 2008;2008:221–6.

    Article  Google Scholar 

  45. Harr JN, Brody F. Sports hernia repair with adductor tenotomy. Hernia. 2016;21(1):139–47.

    Article  Google Scholar 

  46. Gill TJ, Carroll KM, Makani A, Wall AJ, Dumont GD, Cohn RM. Surgical technique for treatment of recalcitrant adductor longus tendinopathy. Arthrosc Tech. 2014;3(2):e293–7.

    Article  Google Scholar 

  47. Atkinson HD, Johal P, Falworth MS, Ranawat VS, Dala-Ali B, Martin DK. Adductor tenotomy: its role in the management of sports-related chronic groin pain. Arch Orthop Trauma Surg. 2010;130(8):965–70.

    Article  Google Scholar 

  48. Lloyd DM, Sutton CD, Altafa A, Fareed K, Bloxham L, Spencer L, et al. Laparoscopic inguinal ligament tenotomy and mesh reinforcement of the anterior abdominal wall: a new approach for the management of chronic groin pain. Surg Laparosc Endosc Percutan Tech. 2008;18(4):363–8.

    Article  Google Scholar 

  49. Paajanen H, Syvähuoko I, Airo I. Totally extreparitoneal endoscopic (TEP) treatment of sportsman’s hernia. Surg Laparosc Endosc Percutan Tech. 2004;14:215–8.

    Article  Google Scholar 

  50. van Veen RN, de Baat P, Heijboer MP, Kazmemier G, Punt BJ, Dwarkasing RS, et al. Successful endoscopic treatment of chronic groin pain in athletes. Surg Endosc. 2007;21:189–93.

    Article  Google Scholar 

  51. Ziprin P, Prabhudesai SG, Abrahams S, Chadwick SJ. Transabdominal preperitoneal laparoscopic approach for the treatment of sportsman’s hernia. J Laparoendosc Adv Surg Tech. 2008;18:669–72.

    Article  Google Scholar 

  52. Ingoldby C. Laparoscopic and conventional repair of groin disruption in sportsmen. Br J Surg. 1997;84:213–5.

    Article  CAS  Google Scholar 

  53. Rossidis G, Perry A, Abbas H, Motamarry I, Lux T, Farmer K, et al. Laparoscopic hernia repair with adductor tenotomy for athletic pubalgia: an established procedure for an obscure entity. Surg Endosc. 2015;29(2):381–6.

    Article  Google Scholar 

  54. Schilders E, Dimitrakopoulou A, Cooke M, Bismil Q, Cooke C. Effectiveness of a selective partial adductor release for chronic adductor-related groin pain in professional athletes. Am J Sports Med. 2013;41(3):603–7.

    Article  Google Scholar 

  55. Maffulli N, Loppini M, Longo UG, Denaro V. Bilateral mini-invasive adductor tenotomy for the management of chronic unilateral adductor longus tendinopathy in athletes. Am J Sports Med. 2012;40(8):1880–6.

    Article  Google Scholar 

  56. Polglase AL, Frydman GM, Farmer KC. Inguinal surgery for debilitating chronic groin pain in athletes. Med J Aust. 1991;155:674–7.

    CAS  PubMed  Google Scholar 

  57. Messaoudi N, Jans C, Pauli S, Van Riet R, Declercq G, Van Cleemput M. Surgical management of sportsman’s hernia in professional soccer players. Orthopedics. 2012;35(9):e1371–5.

    Article  Google Scholar 

  58. Joesting DR. Diagnosis and treatment of sportsman’s hernia. Curr Sports Med Rep. 2002;1:121–4.

    Article  Google Scholar 

  59. Kopelman D, Kaplan U, Hatoum OA, Abaya N, Karni D, Berber A, et al. The management of sportsman’s groin hernia in professional and amateur soccer players: a revised concept. Hernia. 2016;20(1):69–75.

    Article  CAS  Google Scholar 

  60. Evans DS. Laparoscopic transabdominal pre-peritoneal (TAPP) repair for groin hernia: one surgeon’s experience of a developing technique. Ann R Coll Surg Engl. 2002;84:393–8.

    Article  Google Scholar 

  61. Genitsaris M, Goulimaris I, Sikas N. Laparoscopic repair of groin pain in athletes. Am J Sports Med. 2004;32(5):1238–42.

    Article  Google Scholar 

  62. Mann CD, Sutton CD, Garcea G, Lloyd DM. The inguinal release procedure for groin pain: initial experience in 73 sportsmen/women. Br J Sports Med. 2009;43(8):579–83.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Wen Hui Tan MD & L. Michael Brunt MD

  2. Department of Surgery, Washington University School of Medicine, 660 S Euclid Avenue, Box 8109, St. Louis, MO, 63110, USA

    Wen Hui Tan MD & L. Michael Brunt MD

  3. St. Louis Blues Hockey Club, St. Louis, MO, USA

    L. Michael Brunt MD

Authors
  1. Wen Hui Tan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Michael Brunt MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L. Michael Brunt MD .

Editor information

Editors and Affiliations

  1. Surgeons Group of Baton Rouge of Our Lady of the Lake Physician Group, Baton Rouge, Louisiana, USA

    Karl A. LeBlanc

  2. Peninsula College of Medicine and Dentistry (Emeritus), Plymouth, United Kingdom

    Andrew Kingsnorth

  3. North Devon District Hospital, Barnstaple, United Kingdom

    David L. Sanders

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Tan, W.H., Michael Brunt, L. (2018). Management of Abdominal Wall Hernias, Sports Hernias, and Athletic Pubalgia. In: LeBlanc, K., Kingsnorth, A., Sanders, D. (eds) Management of Abdominal Hernias. Springer, Cham. https://doi.org/10.1007/978-3-319-63251-3_19

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-63251-3_19

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-63250-6

  • Online ISBN: 978-3-319-63251-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation