Advertisement

Sportsmen Hernia

  • Salvador Morales-Conde
  • Moshe Dudai
  • Andreas Koch
Chapter

Abstract

Sportsmen hernia (SH) is one of the least understood, poorly defined, and under-researched maladies to affect the human body and is a leading cause of athletes’ retirement from competitive sports. It is more common in high-level athletes, although it could be also present in active young people. It is an obscure condition of uncertain etiology commonly seen in soccer, football, rugby, and ice hockey players. It reflects a compilation of diagnoses grouped together with a wide range of other pathologies that need to be excluded before this should be considered as a diagnosis. The top five causes for groin pain in athletes have been determined in a recent systematic review 7 [1] and include femoroacetabular impingement (FAI) (32%), athletic pubalgia (24%), adductor-related pathology (12%), inguinal pathology (10%), and labral pathology (5%), with 35% of this labral pathology specifically attributed to FAI.

References

  1. 1.
    de Sa D, Hölmich 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. 2016:1181–6.Google Scholar
  2. 2.
    Caudill P, Nyland J, Smith C, Yerasimides J, Lach J. Sports hernias: a systematic literature review. Br J Sports Med. 2008;42:954–64.CrossRefPubMedGoogle Scholar
  3. 3.
    Minnich JM, Hanks JB, Muschaweck U, Brunt LM, Diduch DR. Sports hernia: diagnosis and treatment highlighting a minimal repair surgical technique. Am J Sports Med. 2011;39(6):1341–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Meyers WC, McKechnie A, Philippon MJ, Horner MA, Zoga AC, Devon ON. Experience with “sports hernia” spanning two decades. Ann Surg. 2008;248(4):656–65.PubMedGoogle Scholar
  5. 5.
    Meyers WC, Foley DO, Garrett WE, et al. Management of severe lower abdominal or inguinal pain in high-performance athletes. Performing athletes with abdominal or inguinal neuromuscular Pain Study Group (PAIN). Am J Sports Med. 2000;28:2–8. 4CrossRefPubMedGoogle Scholar
  6. 6.
    Sheen AJ, Paajanen H. The next step towards rational treatment for ‘The sportsman’s groin. Br J Sports Med. 2015;49(12):764–5.CrossRefPubMedGoogle Scholar
  7. 7.
    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.CrossRefPubMedGoogle Scholar
  8. 8.
    Fon LJ, Spence RA. Sportsman’s hernia. Br J Surg. 2000;87:545–52.CrossRefPubMedGoogle Scholar
  9. 9.
    Holmich P, Dienst M. Differential diagnosis of hip and groin pain. Symptoms and technique for physical examination. Orthopade. 2006;35(1):8. 10–5CrossRefPubMedGoogle Scholar
  10. 10.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Farber AJ, Wilckens JH. Sports hernia: diagnosis and therapeutic approach. J Am Acad Orthop Surg. 2007;15:507–14.CrossRefPubMedGoogle Scholar
  12. 12.
    Hölmich P, Hölmich LR, Bjerg AM. Clinical examination of athletes with groin pain: an intraobserver and interobserver reliability study. Br J Sports Med. 2004;38(4):446–51.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Lilly MC, Arregui ME. Ultrasound of the inguinal floor for evaluation of hernias. Surg Endosc. 2002;16(4):659–62.CrossRefPubMedGoogle Scholar
  14. 14.
    Lorenzini C, Sofia L, Pergolizzi FP, Trovato M. The value of diagnostic ultrasound for detecting occult inguinal hernia in patients with groin pain. Chir Ital. 2008;60(6):813–7.PubMedGoogle Scholar
  15. 15.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Depasquale R, Landes C, Doyle G. Audit of ultrasound and decision to operate in groin pain of unknown aetiology with ultrasound technique explained. Clin Radiol. 2009;64(6):608–14.CrossRefPubMedGoogle Scholar
  17. 17.
    Barile A, Erriquez D, Cacchio A, De Paulis F, Di Cesare E, Masciocchi C. Groin pain in athletes: role of magnetic resonance. Radiol Med (Torino). 2000;100(4):216–22.Google Scholar
  18. 18.
    Paajanen H, Hermunen H, Karonen J. Pubic magnetic resonance imaging findings in surgically and conservatively treated athletes with osteitis pubis compared to asymptomatic athletes during heavy training. Am J Sports Med. 2008;36(1):117–21.CrossRefPubMedGoogle Scholar
  19. 19.
    Kuikka L, Hermunen H, Paajanen H. Effect of pubic bone marrow edema on recovery from endoscopic surgery for athletic pubalgia. Scand J Med Sci Sports. 2015;25(1):98–103. https://doi.org/10.1111/sms.12158. Epub 2013 Dec 18.CrossRefPubMedGoogle Scholar
  20. 20.
    Garvey JF. Computed tomography scan diagnosis of occult hernia. Hernia. 2012;16:307–14.CrossRefPubMedGoogle Scholar
  21. 21.
    Swan KG Jr, Wolcott M. The athletic hernia: a systematic review. Clin Orthop Relat Res. 2007;455:78–87.CrossRefPubMedGoogle Scholar
  22. 22.
    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;18:263–74.CrossRefPubMedGoogle Scholar
  23. 23.
    Hölmich P, Uhrskou P, Ulnits L, et al. Effectiveness of active physical training as treatment for long-standing adductor – related groin pain in athletes: randomised trial. Lancet. 1999;353:439–43.CrossRefPubMedGoogle Scholar
  24. 24.
    Comin J, Obaid H, Lammers G, Moore J, Wotherspoon M, Connell D. Radiofrequency denervation of the inguinal ligament for the treatment of ‘Sportsman’s Hernia’: a pilot study. Br J Sports Med. 2013;47:380–6.CrossRefPubMedGoogle Scholar
  25. 25.
    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.CrossRefPubMedGoogle Scholar
  26. 26.
    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;150:99–107.CrossRefPubMedGoogle Scholar
  27. 27.
    Boyle J, Withers K, Singer KP. Prevention of groin injuries in the elite Australian rules footballer – 8 year clinical perspective. Manuelle Therapie. 2008;12:131–5.CrossRefGoogle Scholar
  28. 28.
    Moeller JL. Sportsman’s hernia. Curr Sports Med Rep. 2007;6(2):111–4.PubMedGoogle Scholar
  29. 29.
    Kaplan O, Arbel R. Sportsman’s hernia – a plea for conservative therapeutical approach. Harefuah. 2005;144(5):351–6. 381PubMedGoogle Scholar
  30. 30.
    Steele P, Annear P, Grove JR. Surgery for posterior inguinal wall deficiency in athletes. J Sci Med Sport. 2004;7:415–21.CrossRefPubMedGoogle Scholar
  31. 31.
    Šebečić B, Japjec M, Janković S, Čuljak V, Dojčinović B, Starešinić M. Is chronic groin pain a Bermuda triangle of sports medicine? Acta Clin Croat. 2014;53(4):471–8.PubMedGoogle Scholar
  32. 32.
    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.CrossRefPubMedGoogle Scholar
  33. 33.
    Mei-Dan O, Lopez V, Carmont MR, McConkey MO, Steinbacher G, Alvarez PD, et al. Adductor tenotomy as a treatment for groin pain in professional soccer players. Orthopedics. 2013;36(9):e1189–97.CrossRefPubMedGoogle Scholar
  34. 34.
    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.CrossRefPubMedGoogle Scholar
  35. 35.
    Jans C, Messaoudi N, Pauli S, Van Riet RP, Declercq G. Results of surgical treatment of athletes with sportsman’s hernia. Acta Orthop Belg. 2012;78(1):35–40.PubMedGoogle Scholar
  36. 36.
    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.CrossRefPubMedGoogle Scholar
  37. 37.
    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 Aug;40(8):1880–6.CrossRefPubMedGoogle Scholar
  38. 38.
    Ingoldby CJ. Laparoscopic and conventional repair of groin disruption in sportsmen. Br J Surg. 1997;84:1171–2.CrossRefGoogle Scholar
  39. 39.
    Susmallian S, Ezri T, Elis M, Warters R, Charuzi I, Muggia-Sullam M. Laparoscopic repair of “sportsman’s hernia” in soccer players as treatment of chronic inguinal pain. Med Sci Monit. 2004;10:52–4.Google Scholar
  40. 40.
    Srinivasan A, Schuricht A. Long-term follow-up of laparoscopic preperitoneal hernia repair in professional athletes. J Laparoendosc Adv Surg Tech A. 2002;12:101–6.CrossRefPubMedGoogle Scholar
  41. 41.
    van Veen RN, de Baat P, Heijboer MP, Kazemier G, Punt BJ, Dwarkasing RS, et al. Successful endoscopic treatment of chronic groin pain in athletes. Surg Endosc. 2007;21:189–93.CrossRefPubMedGoogle Scholar
  42. 42.
    Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009;13(4):343–403.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Miserez M, Peeters E, Aufenacker T, Bouillot JL, Campanelli G, Conze J, et al. Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2014;18(2):151–63.CrossRefPubMedGoogle Scholar
  44. 44.
    Bittner R, Arregui ME, Bisgaard T, Dudai M, Ferzli GS, Fitzgibbons RJ, et al. Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS)]. Surg Endosc. 2011;25(9):2773–843.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Bittner R, Montgomery MA, Arregui E, Bansal V, Bingener J, Bisgaard T, et al. Update of guidelines on laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia (International Endohernia Society). Surg Endosc. 2015;29(2):289–321.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Poelman MM, van den Heuvel B, Deelder JD, Abis GS, Beudeker N, Bittner RR, et al. EAES consensus development conference on endoscopic repair of groin hernias. Surg Endosc. 2013;27(10):3505–19.CrossRefPubMedGoogle Scholar
  47. 47.
    Genitsaris M, Goulimaris I, Sikas N. Laparoscopic repair of groin pain in athletes. Am J Sports Med. 2004;32:1238–42.CrossRefPubMedGoogle Scholar
  48. 48.
    Harmon KG. Evaluation of groin pain in athletes. Curr Sports Med Rep. 2007;6:354–61.PubMedGoogle Scholar
  49. 49.
    Paajanen H, Montgomery A, Simon T, Sheen AJ. Systematic review: laparoscopic treatment of long-standing groin pain in athletes. Br J Sports Med. 2015;49(12):814–8.CrossRefPubMedGoogle Scholar
  50. 50.
    Śmietański M, Śmietańska IA, Modrzejewski A, Simons MP, Aufenacker TJ. Systematic review and meta-analysis on heavy and lightweight polypropylene mesh in Lichtenstein inguinal hernioplasty. Hernia. 2012;16(5):519–28.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Salvador Morales-Conde
    • 1
  • Moshe Dudai
    • 2
  • Andreas Koch
    • 3
  1. 1.Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive SurgeryUniversity Hospital “Virgen del Rocío”SevillaSpain
  2. 2.Surgery, Hernia-ExcellenceRamat Aviv Medical CenterTel AvivIsrael
  3. 3.Day Surgery and Hernia CenterCottbusGermany

Personalised recommendations