The Sportsman’s Groin or hernia has come by way of many different names over the years: athletic pubalgia, Gilmore’s groin, sports hernia, incipient hernia, inguinal disruption and groin disruption to name a few.
In order to establish some consensus by which to guide our clinical practice, the British Journal of Sports Medicine published an article titled “Treatment of the Sportsman’s groin”: British Hernia Society’s 2014 position statement based on the Manchester Consensus Conference.
The new nomenclature for this condition is now Inguinal Disruption. It is characterized by pain, insidious or acute, predominantly near the pubic tubercle where no obvious other pathology exists.
It needs 3/5 clinical signs for diagnosis:
- Pinpoint tenderness over the pubic tubercle at the point of insertion of the conjoint tendon
- Palpable tenderness over the deep inguinal ring
- Pain and/or dilation of the external ring with no obvious hernia
- Pain at the origin of the adductor longus tendon
- Dull, diffused pain in the groin, often radiating to the perineum and inner thigh or across the midline
Posterior wall weakness of the inguinal canal, external ring dilation, conjoint tendon damage, inguinal ligament tears
MRI of the groin is the preferred method to diagnose inguinal disruption (mainly by its exclusion of other pahtology). An ultrasound may be of some benefit.
Surgery is not always required. Conservative treatments should be tried first, including rest, structured exercises including those focused on core stabilization, physiotherapy, anti-inflammatories and local steroid injection.
If there is ongoing pain after 1-2 months of rehabilitation then consider surgical repair. Surgery is required in approximately 60% of the cases.
In terms of which surgical approach, laparoscopic vs. open, there was no RCT data to suggest that any technique was superior. The surgery will identify pathology, releasing abnormal tension on the inguinal ligament if present and restore strength in the posterior wall with a suture or mesh reinforcement.
Br J Sports Med 2014 48:1079-1087. Sheen, Aali J et al.