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).

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:

• Inflammation of the adductor muscle of the thigh
• Rupture of the adductor muscle of the thigh
• Inflammation of the pubic joint (osteitis pubis)
• Bursitis on the front of the hip joint (bursitis iliopectinea)
• Other bursitis
• Fluid accumulation in the hip joint
• Degenerative arthritis in the hip joint
• Rupture of the superficial hip flexor (ruptura musculus rectus femoris)
• Rupture of the deep hip flexor (ruptura musculus iliopsoas)
• Outer snapping hip
• Inner snapping hip
• Inguinal hernia
• Stress fracture in the femoral neck
• Nerve entrapment
• Lumbago
• Piriformis syndrome