Surgery for groin and lower abdominal pain in soccer players.

Bahar A, Soudry M. Harefuah 2000 Jul;139(1-2):29-32, 78.

We treated 57 professional soccer players with groin and lower abdominal pain, 44 of them successfully, using conservative methods and 13 by surgery. Because of its anatomical site, the gracilis muscle is involved in almost all movements of the femur. It therefore is frequently involved in injury due to overuse, especially at its insertion (enthesopathy). In all 13 operated on, the gracilis was cut percutaneously, sometimes as a single procedure and sometimes with concomitant sportsmen’s inguinal hernioplasty. All except 1 of those operated on returned to their professional sport activities.

Groin pain associated with ultrasound finding of inguinal canal posterior wall deficiency in Australian Rules footballers.

Orchard JW, Read JW, Neophyton J, Garlick D. Br J Sports Med 1998 Jun;32(2):134-9.

OBJECTIVES.
To investigate the prevalence of inguinal canal posterior wall deficiency (sports hernia) in professional Australian Rules footballers using an ultrasound technique and correlate the results with the clinical symptom of groin pain.

METHODS.
Thirty five professional Australian footballers with and without groin pain were investigated blind with a dynamic high resolution ultrasound technique for presence of posterior wall deficiency.

RESULTS.
Fourteen players had a history of significant recent groin pain and ten of these were found to have bilateral inguinal canal posterior wall deficiency (p < 0.01). The relative risk for a history of groin pain with bilateral deficiency was 8.0 (95% confidence interval 1.73 to 37.1). Groin pain was also found to be associated with increasing age (p < 0.01) which was an independent risk factor. Surgical, clinical, and ultrasound follow up for players who underwent hernia repair confirmed the validity of ultrasound as a diagnostic tool.

CONCLUSIONS.
Dynamic ultrasound examination is able to detect inguinal canal posterior wall deficiency in young males with no clinical signs of hernia. This condition is very prevalent in professional Australian Rules footballers, including some who are asymptomatic. There was a correlation between bilateral deficiency and groin pain, although the temporal relationship between the clinical and ultrasound findings is not established by the current study. Ultrasound shows promise as a diagnostic tool in athletes with chronic groin pain who are considered possible candidates for hernia repair.

Detection of groin hernia with physical examination, ultrasound, and MRI compared with laparoscopic findings.

van den Berg JC, de Valois JC, Go PM, Rosenbusch G. Invest Radiol 1999 Dec;34(12):739-43.

OBJECTIVE.
To determine the diagnostic accuracy of physical examination, ultrasound, and dynamic MRI in patients with inguinal hernia.

METHODS.
In 41 patients with clinically evident herniations, 82 groins were evaluated using a standard ultrasound and MRI protocol, the latter including T1- and T2-weighted sequences as well as two dynamic sequences. All ultrasound examinations and MRI scans were reviewed without knowledge of clinical findings. In all cases, correlation with findings at laparoscopic surgery was made.

RESULTS.
At surgery, 55 inguinal herniations were found. Physical examination revealed 42 herniations (one false-positive finding), whereas ultrasound made the diagnosis of a hernia in 56 cases (five false-positive and four false-negative findings). MRI diagnosed 53 herniations (one false-positive and three false-negative findings). Thus, sensitivity and specificity figures were 74.5% and 96.3% for physical examination, 92.7% and 81.5% for ultrasound, and 94.5% and 96.3% for MRI.

CONCLUSIONS.
In patients with clinically uncertain herniations, MRI is a valid diagnostic tool with a high positive predictive value.

Longstanding groin pain in athletes. A multidisciplinary approach.

Ekberg O, Persson NH, Abrahamsson PA, Westlin NE, Lilja B. Sports Med 1988 Jul;6(1):56-61.

In 21 male athletes (age 20 to 40 years) with longstanding unexplained groin pain, a multidisciplinary investigation was performed in order to reveal the underlying cause. These examinations included general surgery for detection of inguinal hernia and neuralgia, orthopaedic surgery for detection of adductor tenoperiostitis and symphysitis, urology for detection of prostatitis, radiology for performing herniography and plain film of the pelvic bones, nuclear medicine for isotope studies of the pubic bone and symphysis. In 19 patients there was a positive diagnosis for 2 or more of the diseases (10 patients had 2 diseases, 6 patients had 3 diseases, 3 patients had 4 diseases). Two patients had only signs of symphysitis. Our results show the complexity of longstanding groin pain in athletes. It also explains why therapy for one specific disease entity may fail. We conclude that this clinical setting demands the recruitment of a team with experience of different aspects of groin pain.