Sports hernia athletic pubalgia a sports hernia is a painful, soft tissue injury that occurs in the groin area. Athletic pubalgia and sports hernia rsna publications online. Any information contained in this pdf file is automatically generated from digital material. Athletic pubalgia is a syndrome that encompasses a wide list of injuries involving attachment disruption and instability. Treatment protocols for sports hernia remain controversial. Sports hernia or athletic pubalgiacausessymptomstreatment.
It is increas ingly recognized in athletes as a source of groin pain and is often associated with other pathology. It is a syndrome characterized by chronic groin pain in athletes and a dilated superficial ring of the inguinal canal. This syndrome is multifaceted and lacks true definition. The hallmark complaint of athletic pubalgia is a deep groin or lower abdominal pain with exertion. Anatomic basis for evaluation of abdominal and groin pain in athletes. Athletic pubalgia is a general term that encompasses a wide range of injuries at the symphysis pubis that share a similar injury mechanism and clinical presentation of exertional pubic and groin pain 5. Athletic pubalgia ap has been reported to afflict athletes who participate in sports that entail repetitive twisting and turning while moving e. Previously described in highperformance athletes, ap has also been reported to occur in recreational athletes.
Athletic pubalgia was diagnosed on physical examination by a sports physician and a surgeon and confirmed by at least one imaging technique showing injury to the abdominal wall attachment site andor adductors. Athletic pubalgia and associated rehabilitation europe pmc. It includes large fieldofview sequences of the bony pelvis as well as smaller fieldofview sequences of the pubic symphysis 36. Athletic pubalgia, more commonly known as sports hernia, is defined as chronic lower abdominal and groin pain without the presence of a true hernia. Athletic pubalgia is an umbrella term for career ending, or qualityoflifethreatening, musculoskeletal injuries involving attachments andor soft tissue support structures. Although the symptoms are similar, the pain and pressure from sports hernias are caused by torn tendons that attach to the pelvis instead of an abdominal muscle separation. Surgery for athletic pubalgia has been performed concurrently with treatment of fai, or following fai surgery if symptoms did not. In order to regain balance of the soft tissue, reduced tension of these muscles should be addressed. The main cause of sports hernia athletic pubalgia is the hard and sudden planting of the feet andor twisting of the body at an intense level, usually during sports. Mr imaging technique and findings of athletic pubalgia. Athletic pubalgia groin pain in an individual that cannot be attributed to hip joint or hip tendon pathology, often in competitive athletes may be acute, but is more often chronic.
Both the american academy of orthopedic surgeons aaos and the american orthopedic society for sports medicine aossm use of the term sports hernia to describe only one specific injuryathletic pubalgia. Studies are limited, however, lacking consistent objective criteria for making the diagnosis and assessing outcomes. Experience over the last couple decades has begun to unify this spectrum of pathology around a common theory of causation. In soccer, groin and lower abdominal pain accounts for 10% of injuries per year. Although some authors distinguish between the terms sports hernia and athletic pubalgia, there is considerable overlap in patient presentation and anatomic structures involved. A hernia happens when an organ or tissue sticks through the muscle or tissue that holds it in place. It is either a musculotendinous or osseous injury that involves the insertion of abdominal muscles on the pubis and the upper aponeu. Typically athletic pubalgia is believed to be multifaceted, occurring with a twisting motion exacerbated by planting the foot at high speeds, sudden sharp changes in direction, repetitive kicking, and lateral motion. Athletic pubalgia surgery medical clinical policy bulletins.
Of the 79 patients with mripositive athletic pubalgia. These muscles and tendons may be part of your abdominal wall or your leg. Kicking a soccer ball, shooting a hockey puck, or turning to receive a lacrosse ball are all examples of sports plays that can cause sports hernia. Athletic pubalgia refers to lower abdominal and groin pain arising from an injury to. Inflexible, tight, damaged and weakened hip flexor muscles and inner thigh and groin muscles that stretch the lower abdominal muscles and bend pelvis forward often lead to the gradual development of sports hernia. Athletic pubalgia chronic inguinal or pubic area pain pain only on exertion no other medical diagnosis biomechanical injury weak lower abdominals resulting in anterior pelvic tilt overuse of adductors and lower abs meyers wc et al. Athletic pubalgia, also known as gilmores groin, sportssportsmans hernia or occult hernia is a condition limited almost exclusively to professional or other highperformance athletes.
It is either a musculotendinous or osseous injury that involves the insertion of abdominal muscles on the pubis and the upper aponeurotic insertion of the adductor muscles. Surgery for athletic pubalgia has been performed concurrently with treatment of fai, or following fai surgery if symptoms did not resolve. However, due to the number of potential differential diagnoses for athletes with chronic pain in the groin and lower abdominal region. On 24 of the 119 mris, the valsalva maneuver either revealed the finding or made it significantly more apparent. Sports hernia or athletic pubalgia is a chronic condition which often results from overuse of groin area and repeated trauma.
Oct 03, 20 athletic pubalgia is a general term for many of the pubic bonebased muscle or tendon injuries. Failure to treat both pathologies resulted in a low return to sport rate 25 % of athletic pubalgia was addressed in isolation, and 50 % of the intraarticular hip pathology was addressed in isolation. Sports herniaathletic pubalgia is activityrelated lower abdominal and proximal adductorrelated pain seen in athletes. Unlike hernias, the pain of athletic pubalgia occurs in. Athletic pubalgia an overview sciencedirect topics. The general public and media are more familiar with sports hernia, however, and this term will be used for the remainder of this article. This pain tends to be deeper and more intense than an adductor or iliopsoas strain and is ipsilateral in nature. To summarise the present data regarding anatomy, biomechanics, clinical. Athletic pubalgia sports hernia sports medicine today. Oct 24, 2016 the role of imaging modalities in the diagnosis of hip and groin pain, and specifically for athletic pubalgia, continues to evolve. The medial and lateral tendons that arise from the anterior pubis contribute to the common muscle. Results suggested that athletic pubalgia may be the real cause of anterior groin pain in a considerable. This condition, which is also called sportsmans hernia or athletic pubalgia, refers to an occult hernia that is caused by weakness or a tear of the posterior inguinal wall without a clinically recognizable hernia that leads to a condition of chronic groin pain 4,8,63,64 figures 25.
Athletic pubalgia according to hayes, athletic groin pain i. Although a sports hernia may lead to a traditional, abdominal hernia, it is a different injury. Differential diagnosis of a sports hernia in a highschool. Imaging of athletic pubalgia and core muscle injuries. Both the american academy of orthopedic surgeons aaos and the american orthopedic society for sports medicine aossm use of the term sports hernia to describe only one specific injury athletic pubalgia. Sports hernia athletic pubalgia is activityrelated lower abdominal and proximal adductorrelated pain seen in athletes. The paired rectus abdominis muscles play an integral role in stabilising the muscular core, and blend with the adductor longus origins to form a dense, fibrous. The term athletic pubalgia seems a much better fit than sports hernia since the former term captures the idea of multiple possible afflictions around the pubis and does not connote a likely misleading cause of pain. Athletic pubalgia is defined as pain in the groin area of an athlete. Eightyeight percent reported that the surgery was a success at followup. Athletic pubalgia involves a wide variety of structures surrounding the pelvis and often results in cessation of physical activity.
Athletic pubalgia is a term grossly misunderstood throughout the sports medicine community. Some practitioners advise nonsurgical treatments such as rest, antiinflammatory medications, and physical therapy. Fibers from the rectus abdominus, conjoint tendon a fusion of the internal oblique and transversus abdominus, and external oblique merge to form the pubic. Proposed algorithm for the management of athletes with. However, a largefieldofview magnetic resonance mr imaging survey of the pelvis, combined with highresolution mr imaging of the pubic symphysis, is an excellent means of assessing various causes of athletic pubalgia. Previously described in high performance athletes, ap has also been reported to occur in recreational athletes. For all t1 sequences, please keep te below 20 between 10 and 15 if possible. Athletic pubalgia, also called sports hernia, hockey hernia, hockey groin, gilmores groin, or groin disruption is a medical condition of the pubic joint affecting athletes. Groin pain most commonly develops insidiously, but may present acutely with a clinical history of a sudden tearing sensation. A diagnosis of athletic pubalgia is based primarily on history, physical exam, and imaging. Jun 04, 2018 sports hernia or athletic pubalgia is a chronic condition which often results from overuse of groin area and repeated trauma. Dec 28, 2012 often overlooked and misdiagnosed, pelvic and groin injuries have ended the career of many athletes. A variety of other terms have been used interchangeably to describe this condition including sportsmans hernia, hockey groin, and athletic pubalgia.
Introduction sports hernia, also known as athletic pubalgia, is an elusive condition that is commonly misunderstood by clinicians. Sports herniaathletic pubalgia has received increasing attention as a source of disability and time lost from athletics. Myers 8490 patients 5460 operations the concept of the pubic joint rectus abdominus injury with strong pull of adductors with anterior tilt of the pelvis against the lip of the inferior pubic ramus 17 different nonhip, softtissue structures as cause for primary pain meyers ann surg 2008 surgical options open approaches. The arcuate ligament also merges inferiorly with the aponeuroses of the gra cilis and adductor longus muscles. Postural intervention needs to take place in which of the following positions. Data analysis from medical records of patients with athletic pubalgia attended to. Commonly referred to as sports hernia or osteitis pubis, advances in diagnostic imaging and. Rehabilitation with physical therapy is firstline treatment for most patients with athletic pubalgia. Sports hernia is commonly seen in sports that requires athletes to perform. A suggested model for physical examination and conservative.
Athletic pubalgia sports hernia or gilmores groin sports hernia involves injury to the posterior wall ofthe inguinal canal and can appear as a tear of the transverses abdominis muscle or as a disruption to the conjoined tendon tendon of insertion of the internal oblique and transverses abdominis muscles. Sep 27, 2017 pubalgia is a common injury in the groin area. Until recently, imaging was thought to be unreliable or of little use for the diagnosis of athletic pubalgia, and mr imaging was used mainly to exclude other possible causes of groin pain, such as stress fracture or acetabular labral tear, 37, 38. Its also known as a hockey hernia, gilmores groin, or a sports hernia. The authors concluded that surgical repair of athletic pubalgia in women is successful in. Sports hernia and athletic pubalgia is the first text devoted solely to the topic of sports hernia and will examine its etiology and diagnosis, as well as how to differentiate it from other problems involving the athletes hip area and other injuries it often correlates and interacts with, such as femoroacetabular impingement. Epidemiological profile of patients diagnosed with athletic pubalgia. Shoulderpost gadolinium indirect mr arthrogram inject standard dose of iv contrast and wait 20 minutes before scanning 3. Straining or tearing of any soft tissuemuscle, tendon, or ligamentin the lower abdomen. Athletic pubalgia written by john snyder, pt, dpt, ocs, cscs posted on july 6, 2015 january 5, 2019 4 comments in the next installment of the differential diagnosis series for medbridge education, we are going to take a look at the difficult and complex diagnosis of athletic pubalgia.
Over the last decade this condition has become more commonly described as several wellknown professional athletes have undergone surgical treatment of this condition. Ap is also a challenge for conservative intervention with randomized controlled trials showing mixed success rates. Athletic pubalgia is a clinical syndrome of chronic lower pelvic and groin pain, usually encountered in athletes. Athletic pubalgia is an important clinical syndrome with complex anatomy primarily involves myotendinous structures about the pubic symphysis some interaction with inguinal canal injury and traditional hernia exists at least 4 injury areas need to be assessed. Pdf athletic pubalgia is a term grossly misunderstood throughout the sports medicine community.
The causal mechanisms of athletic pubalgia are poorly. Apr 18, 2012 groin pain is a common complaint in sports involving running, kicking and explosive changes of direction, and as such is frequently encountered by the sports physiotherapist. Request pdf understanding sports hernia athletic pubalgia. Athletic pubalgia, also called sports hernia, core injury, hockey hernia, hockey groin, gilmores groin, or groin disruption is a medical condition of the pubic joint affecting athletes. The anatomic and pathophysiologic basis for abdominal and groin pain in athletes recent. The right and left medial tendons merge with the anterior pubic. Frequently called sports hernia or athletic pubalgia, many surgeons continue to refute the diagnosis because there is a lack of consensus and clear comprehension of the basic. Sports hernia sports hernias, technically known as athletic pubalgia, are not true hernias. Groin pain among athletes, however, may be secondary to. Surgery for groin pain in athletes surgical treatment of groin pain in athletes also known as athletic pubalgia, gilmore groin, osteitis pubis, pubic inguinal pain syndrome, inguinal disruption, slap shot gut, sportsmen groin, footballers groin injury complex, hockey groin syndrome, athletic hernia, sports hernia, or core muscle injury. Athletic pubalgia ap is a chronic debilitating syndrome that affects many athletes.
Groin pain is a common complaint in sports involving running, kicking and explosive changes of direction, and as such is frequently encountered by the sports physiotherapist. Refractory groin pain related to activity is commonly encountered in the sports medicine, orthopaedic surgery, general surgery and now radiology communities. Unfortunately, as poor a term as sports hernia may be, we may be stuck with it since the sports. The term athletic pubalgia is used to describe the disruption andor separation of the more medial common aponeurosis from the pubis, usually with some degree of adductor tendon pathology. Importance groin pain in active individuals and athletes without clinical evidence of hernia or hip pathologic findings is challenging for health care clinicians and aggravating for those experiencing pain. Groin pain is common in sports that require athletes to perform repetitive kicking, twisting, or turning at high speeds, such as football, basketball, track and field, tennis, and most commonly soccer and hockey. We typically obtain an ap pelvis, ap and lateral hip, and 45 dunn view, which has previously been shown to accurately diagnose cam fai. Because different tissues may be affected and a traditional hernia may not exist, the medical community prefers the term athletic pubalgia to refer to this type of injury. This term can encompass multiple entities designated variously in past literature, including gilmores groin, hockey groin, athletic or sports hernia.
The underlying problem in athletic pubalgia is a sprain, tear, or avulsion of a muscle or tendon that originates or terminates on the pubic bone. Core muscle injurysports hernia athletic pubalgia is an increasingly recognized source of pain, disability, and time lost from athletics. A full return to sport is expected at about 68 weeks if an isolated athletic pubalgia repair is performed and 4 months if fai surgery is concomitantly done. It is characterized by pain around the abdomen, groin, hip or thigh. A dedicated athletic pubalgia mri protocol has evolved as the imaging standard for core muscle injuries, particularly if the pathology is felt to be extrinsic to the hip joint. A retrospective single center study on 27 patients who underwent surgery for athletic pubalgia was conducted by kajetanek et al. As a syndrome, ap is difficult to diagnose both with clinical examination and imaging.
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