Understanding "Sports Hernia" (Athletic Pubalgia): The Anatomic and Pathophysiologic Basis for Abdominal and Groin Pain in Athletes

Operative Techniques in Sports Medicine

Volumn 15, Issue 4, 2007, Pages 165-177

  Meyers, William C ^a   Yoo, Edward ^a   Devon, Octavia N ^a   Jain, Nikhil ^a   Horner, Marcia ^a   Lauencin, Cato ^b   Zoga, Adam ^c  

^a DREXEL UNIVERSITY COLLEGE OF MEDICINE   (United States)

^b UNIVERSITY OF VIRGINIA MEDICAL CENTER   (United States)

^c THOMAS JEFFERSON UNIVERSITY HOSPITAL   (United States)

Author keywords

abdomen; athletic pubalgia; core stability; groin; injuries; sports hernia

Indexed keywords

ABDOMINAL PAIN; ABDOMINAL SURGERY; ARTICLE; ATHLETE; COMMERCIAL PHENOMENA; CORRELATION ANALYSIS; HUMAN; IMAGE ANALYSIS; INGUINAL HERNIA; MEDICAL DECISION MAKING; MUSCLE INJURY; NOCICEPTION; NUCLEAR MAGNETIC RESONANCE IMAGING; PATHOLOGICAL ANATOMY; PATHOPHYSIOLOGY; PHYSIOTHERAPY; PRIORITY JOURNAL; RECTUS ABDOMINIS MUSCLE; SOCIAL ASPECT; TENDON INJURY; TRAINING; WORK RESUMPTION;

EID: 38949130788     PISSN: 10601872     EISSN: None     Source Type: Journal    
DOI: 10.1053/j.otsm.2007.09.001     Document Type: Article

References (70)

1. Meyers W.C., Foley D.P., Garrett W.E., et al. Management of severe lower abdominal or inguinal pain in high-performance athletes. Am J Sports Med 28 (2000) 2-8
2. Meyers W.C., Greenleaf R., and Saad A. Anatomic basis for evaluation of abdominal and groin pain in athletes. Oper Tech Sports Med 13 (2005) 55-61
3. Meyers W.C., Lanfranco A., and Castellanos A. Surgical management of chronic lower abdominal and groin pain in high-performance athletes. Curr Sports Med Rep 1 (2001) 301-305
4. Meyers W.C., Ricciardi R., Busconi B.D., et al. Athletic pubalgia and groin pain. In: Garrett W.E., Speer K.P., and Kirkendall D.T. (Eds). Principles and Practice of Orthopedic Sports Medicine (2000), Williams and Wilkins, Philadelphia, Lippincott 223-230
5. Swan K.G., and Wolcott M. The athletic hernia; a systematic review. Clin Orthop Rel Res 455 (2006) 78-87
6. Farber A.J., and Wilckens J.H. Sports hernia: Diagnosis and therapeutic approach. J Am Acad Orthop Surg 15 (2007) 507-514
7. Ekberg O., Blomquist P., and Olsson S. Positive contrast herniography in adult patients with obscure groin pain. Surgery 89 (1981) 532-535
8. Ekberg O., Persson N.H., Abrahamsson P.A., et al. Longstanding groin pain in athletes: A multi-disciplinary approach. Sports Med 6 (1988) 56-61
9. Peterson L., and Renstrom P. Sports Injuries: Their Prevention and Treatment (1983), Martin Dunitz, London
10. Renstrom P., and Peterson L. Groin injuries in athletes. Br J Sports Med 14 (1980) 30-36
11. Smedburg S.G., Broome A.E., Elmer O., et al. Herniography in the diagnosis of obscure groin pain. Acta Chir Scand 151 (1985) 663-667
12. Smodlaka V.N. Groin pain in soccer players. Physician Sportsmed 8 (1980) 57-61
13. Mora S.A., Mandelbaum B.R., Meyers W.C., et al. Extra-articular sources of hip pain. In: Bryd J.W.T. (Ed). Operative Hip Arthroscopy (2005), Springer, New York 70-99
14. Taylor D.C., Meyers W.C., Moylan J.A., et al. Abdominal musculature abnormalities as a cause of groin pain in athletes. Am J Sports Med 19 (1991) 239-242
15. Meyers W.C. Foreward. In: Eubanks S., Soper N., and Swanstrom L. (Eds). Mastery in Endoscopic and Laparoscopic Surgery (1999), Williams and Wilkins, Philadelphia, Lippincott p xix
16. Bittner H.B., Meyers W.C., Brazer S.R., et al. Laparoscopic Nissen fundoplication: Operative results and short-term follow-up. Am J Surg 167 (1994) 193-200
17. Meyers W.C., Foley D.P., Sandor A., et al. Handoscopic surgery: A prospective multicenter trial of a minimally invasive technique for complex abdominal surgery. Arch Surg 134 (1999) 477-486
18. Meyers W.C. Southern Surgeons Club: A prospective analysis of 1518 laparoscopic cholecystectomies. N Engl J Med 324 (1991) 1073-1078
19. Southern Surgeons Club Report on Laparoscopic Hernia Repair. Presented at the annual meeting of the American College of Surgeons in 2000
20. Bozuk M., Schuster R., Stewart D., et al. Disability and chronic pain after open mesh and laparoscopic inguinal hernia repair. Ann Surg 69 (2003) 839-841
21. Genitsaris M., Goulimaris I., and Sikas N. Laparoscopic repair of groin pain in athletes. Am J Sports Med 32 (2005) 1238-1242
22. Ingoldby CJ: Laparoscopic and conventional repair of groin disruption in sportsmen. Br J Surg 84: 213-215 (Comments in Br J Surg 84:1171-1172, 1997)
23. Kumar S., Wilson R.G., Nixon S.J., et al. Chronic pain after laparoscopic and open mesh repair of groin hernia. Br J Surg 89 (2002) 1476-1479 (Comment in Br J Surg 90:368, 2003)
24. Neumayer L., Giobbie-Hurder A., Jonasson O., et al. Open mesh versus laparoscopic mesh repair of inguinal hernia. N Eng J Med 350 (2005) 1819-1827
25. Paajanen H., Syvahuoko I., and Airo I. Totally extraperitoneal endoscopic (TEP) treatment of sportsman's hernia. Surg Laparosc Endosc Percutan Tech 14 (2004) 215-218
26. Susmallian S., Ezri T., Elis M., et al. Laparoscopic repair of "sportsman's hernia" in soccer players as treatment of chronic inguinal pain. Med Sci Monit 10 (2004) CR52-C54
27. Azurin D.J., Go L.S., Schuricht A., et al. Endoscopic preperitoneal herniorrhaphy in professional athletes with groin pain. J Laparoendosc Adv Surg Tech A 7 (1997) 7-12
28. Zoga A.C., Kavanagh E., Omar I., et al. Presentation at the RSNA (2006)
29. Zoga A.C., Morrison W.B., Kavanaugh E.C., et al. MRI of athletic pubalgia: The rectus abdominis/adductor aponeurotic plate. Presentation at the RSNA (2007)
30. Zoga AC, Kavanaugh EC, Omar I, et al: MRI findings in athletic pubalgia and the "sports hernia." Radiology, in press
31. Robinson P., Salehi F., Grainger A., et al. Cadaveric and MRI study of the musculotendinous contributions to the capsule of the symphysis pubis. Am J Roentgenol 188 (2007) W440-W445
32. Brennan D., O'Connell M.J., Ryan M., et al. Secondary cleft sign as a marker of injury in athletes with groin pain: MR image appearance and interpretation. Radiology 235 (2005) 162-167
33. Shortt CP, Zoga AC, Kavanaugh EC, et al: Anatomy, Pathology and MRI findings in "sports hernia." Musculo-skeletal Radiol, in press
34. Merriam G.C., and Webster N. MedlinePlus: Medical Dictionary 2005. http://www2.merriam-webster.com/cgi-bin/mwmednlm?book=Medical&va=joi nt Accessed June 20, 2006
35. Albers S.L., Spritzer C.E., Garrett Jr. W.E., and Meyers W.C. MR findings in athletes with pubalgia. Skeletal Radiol 30 (2001) 270-277
36. Beynnon B.D. Anatomy and biomechanics of the knee. In: Garrett W.E., Speer K.P., and Kirkendall D.T. (Eds). Principles and Practice of Orthopedic Sports Medicine (2000), Williams and Wilkins, Philadelphia, Lippincott
37. Robinson P., Barron D.A., Parsons W., et al. Adductor-related groin pain in athletes: Correlation of MR imaging with clinical findings. Skeletal Radiol 33 (2004) 451-457
38. Gilmore O.J.A. Gilmore's groin: Ten years of experience of groin disruption-a previously unsolved problem in sportsmen. Sports Med Soft Tissue Trauma 3 (1991) 12-14
39. Gilmore O.J.A. Groin pain in the soccer athlete: Fact, fiction, and treatment. Clin Sports Med 17 (1998) 787-793
40. Johnson J.D., and Briner W.W. Primary care of the sports hernia: Recognizing an often-overlooked cause of pain. Phys Sports Med 33 (2005)
41. Kemp S., and Batt M.E. The "sports hernia": A common cause of groin pain. Phys Sports Med 26 (1998)
42. LeBlanc K.E., and LeBlanc K.A. Groin pain in athletes. Hernia 7 (2003) 68-71
43. Llusa M., and Gallester J. Cugat: Groin pain in soccer players. Instructional Course No. 105. International Society of Arthroscopy, Knee Surgery and Orthopedic Sports Medicine (1997) May
44. Morelli V., and Smith V. Groin pain in athletes. Am Family Phys 64 (2001)
45. Musculoskeletal Case No. 9. American Academy of Physical Medicine and Rehabilitation (2001) Jan
46. O'Kane J. Anterior hip pain. Am Family Phys 60 (1999)
47. Orchard J.W., Read J.W., and Verral G.M. Pathophysiology of chronic groin pain in the athlete. ISMJ 1 (2000)
48. Puig P.L., Trouve P., and Savalli L. Pubalgia: From diagnosis to return to the sports field. Ann Readapt Med Phys 47 (2004) 356-364
49. Rodriguez C., Migeul A., Lima H., et al. Osteitis pubis syndrome in the professional soccer athlete: A case report. J Athl Train 36 (2001) 437-440
50. Ruane J.J., and Rossi T.A. When groin pain is more than "just a strain": Navigating a broad differential. Phys Sports Med 26 (1998)
51. Rupp T.J., and Purcell C. Groin injury. In: Malanga G.A. (Ed). Medicine-Instant Access to the Minds of Medicine (2004) Last updated Sept
52. Alam A., Nice C., and Uberoi R. The accuracy of ultrasound in the diagnosis of clinically occult groin hernias in adults. Eur Radiol 15 (2005) 2457-2461
53. Orchard J.W., Read J.W., Neophyton J., et al. Groin pain associated with ultrasound finding of inguinal canal posterior wall deficiency in Australian Rules footballers. Br J Sports Med 32 (1998) 134-139
54. Muschaweck U. Umbilical and epigastric hernia repair. Surg Clin North Am 83 (2003) 1207-1221
55. Irshad K., Feldman L.S., La voie C., et al. Operative management of "hockey groin syndrome": 12 years' experience in National Hockey League players. Surgery 130 (2001) 759-766
56. McKechnie A., and Celebrini R. Hard Core Strength Manual. Vancouver, CA. http://www.p2soccer.com/Content/Main%20Pages/Resource%20Centre.asp
57. Mandelbaum, et al. Presentation at the 2005 MLS Physicians/Trainers Conference in Carson, California (2005) Jan
58. Stenchever M.A. Comprehensive Gynecology. ed 4 (2001), Mosby, Philadelphia
59. In: Pappas T.N., Schwartz L.B., and Eubanks S. (Eds). fsAtlas of Laparoscopic Surgery, Current Medicine (1996), W. B. Saunders, Philadelphia
60. Anda S., Svenningsen S., Grontvedt T., et al. Pelvic inclination and spatial orientation of the acetabulum. A radiographic, computed tomographic and clinical investigation. Acta Radiol 31 (1990) 389-394
61. DiGioia Anthony M.M.D., Jaramaz Branislav PhD., et al. Image guided navigation system to measure intraoperatively acetabular implant alignment. Clin Orthop 355 (1998) 8-22
62. Lembeck B., Mueller O., Reize P., et al. Pelvic tilt makes acetabular cup navigation inaccurate. Acta Orthop 76 (2005) 517-523
63. Murray D.W. The definition and measurement of acetabular orientation. J Bone Joint Surg (Br) 75 (1993) 228-232
64. Kluin J., den Hoed P.T., van Linschoten R., et al. Endoscopic evaluation and treatment of groin pain in the athlete. Am J Sports Med 32 (2004) 944-949
65. In: Canale S., and Campbell Willis C. (Eds). Campbell's Operative Orthopaedics. ed 10 (2002), Mosby, St. Louis, MO 889-890
66. Mckechnie et al: Presentation at the 2005 MLS Physicians/Trainers Conference in Carson, California
67. Holmich P., Uhrskou P., Ulnits L., et al. Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes. Lancet 353 (1999) 439-443
68. Lynch S.A., and Renstrom P.A. Groin injuries in sport: treatment strategies. Sports Med 28 (1999) 137-142
69. Akermark C., and Johansson C. Tenotomy of the adductor longus tendon in the treatment of chronic groin pain in athletes. Am J Sports Med 20 (1992) 640-643
70. Biedert R.M., Warnke K., and Meyer S. Symphysis syndrome in athletes: Surgical treatment for chronic lower abdominal, groin, and adductor pain in athletes. Clin J Sport Med 13 (2003) 278-284