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Sportsman's hernia

SPORTSMANS HERNIA

Diagnosis: "SPORTSMAN’S HERNIA"

Anatomy:
The various muscles of the abdominal wall are penetrated by the inguinal canal, which contains nerves (N ilioinguinalis and the genital branch of N genitofemoralis) and in men the spermatic cord (funilicus spermaticus). In women the inguinal canal instead contains a small fibrous ligament. Where the inguinal canal penetrates the abdominal wall weak spots arise (anulus inguinalis superficialis and anulus inguinalis profundus).




  1. M. recti abdominis

  2. Funiculus spermaticus

  3. Ligamentum inguinale

  4. Spina iliaca anterior superior

  5. M. obliquus externus abdominis

INGUINAL CANAL




  1. Anulus inguinalis superficialis

  2. Crus mediale

  3. Funiculus spermaticus
    et m. cremaster


  4. V. femoralis

  5. Hiatus saphenus

  6. Lig. lacunare

  7. Anulus femoralis

  8. Margo falciformis
    (cornu superius)


  9. Lig inguinale

  10. Fibrae intercrurales

  11. M. obliquus externus abdominis

RIGHT INGUINAL CANAL

Cause: The existence of "sportsman’s hernia" is debated amongst professionals (article 1). Generally it involves a inguinal hernia (direct hernia), that can not be detected with certainty neither before nor after surgery. Some consider the condition to be an early stage of an imminent inguinal hernia, while others believe it to be small ruptures in the muscles and tendons around the inguinal canal (article 2) (article 3).

Symptoms: Pain in the groin without any detectable swelling in the groin or any other explanation for the pain.

Examination: There are no examinations (X-ray, ultrasound, MRI-scan, scintigraphy), that can detect the sportsman’s hernia (article). Previously used attempts with X-ray contrast in the abdominal cavity (herniography) showed "sportsman’s hernia" in 49% of healthy subjects, which naturally renders the examination unusable.

Treatment: Before you choose to be operated for "sportsman’s hernia", all non-operative possibilities should be attempted, including sufficient relief and rehabilitation of the most tender structures and muscles.

Training of the muscles around the groin, stomach and loin before possible surgery.

Complications: Since it may be difficult to make a correct diagnosis in athletes with long-term groin pain (article). A multidisciplinary approach, it should be supplemented with, amongst other things, ultrasound scan and consideration of X-ray scintigraphy and possibly MRI-scan. You should of course consider the correctness of the diagnosis and amongst other things consider the following:
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