Pubic Inguinal Pain Syndrome (PIPS)

Abstract

Pubic inguinal pain syndrome commonly presents as a painful groin in those sports that involve kicking and twisting movements while running such as football, rugby, and soccer. The pain experience is recognized at the common point of origin of the rectus abdominis muscle and the adductor longus tendon on the pubic bone. Although it is usually known as “sportsman’s hernia,” it may also appear in normally physically active people. Moreover it is accepted that this chronic pain caused by abdominal wall weakness occurs without a palpable hernia. For all this reason, we proposed the new name “pubic inguinal pain syndrome (PIPS).”

For all patients we suggested conservative treatment and then, if it was not effective, surgical treatment.

Our etiopathogenetic theory pain is caused by three factors:

• 1. The compression of the three nerves of the inguinal region

• 2. The imbalance in strength of adductor and abdominal wall muscles caused by the hypertrophy and stiffness of the insertion of the rectus muscle and adductor longus muscle

• 3. The partial weakness of the posterior wall

We also found during surgery an unusual thickening posterior to the rectus under the Duglas’s line, where there should not be any band.

Our surgical procedure includes the release of all three nerves of the region; the correction of the imbalance; the partial tenotomy of the rectus, adductor longus muscle, and thickening posterior to the rectus abdominis; and repair of the partial weakness of the posterior wall with a lightweight mesh.