The sportsman's hernia--fact or fiction?
ABSTRACT This review is based on the results of 308 operations for unexplained, chronic groin pain suspected to be caused by an imminent, but not demonstrable, inguinal hernia: the 'sportsman's hernia' (SH). No differences in perioperative findings between cured and non-cured athletes were found. However, there was a remarkable difference between the various perioperative findings in the studies. It was characteristic that further clinical investigation of the noncured, operated athletes gave an alternative and treatable diagnosis in more than 80% of cases. Herniography was used consistently in the diagnostic process in all the studies on SH. However, in 49% of cases hernias were also demonstrated on the opposite, asymptomatic groin side. In conclusion, the final diagnosis (and treatment) often reflects the speciality of the doctor and the present literature does not supply proper evidence to the theory that SH constitutes a credible explanation for chronic groin pain.
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ABSTRACT: Groin pain is defined as tendon enthesitis of adductor longus muscle and/or abdominal muscles that may lead to degenerative arthropathy of pubic symphisis in an advanced stage. Pubic region is a point where kinematic forces cross. The balance between the adductor and abdominal muscles is of great importance, as well as the elasticity of pubic symphisis which enables movement of up to 2 mm and rotation of up to 3 degrees. The weakness of the abdominal muscle wall, known as the sportsman's hernia, is the most common cause of painful groin. Groin pain is the most common in soccer players (6.24% in Croatia). Most authors believe that the main cause of groin pain is the adductor muscle overload. When active, sportsmen start to feel a dull pain in the groin region. The adductor test is of great importance for physical examination; the patient should be lying supine with his hips abducted and flexed at 80 degrees. The test is positive if the patient, while attempting to pull his/her legs against pressing in the opposite direction, feels a sharp pain in the groins. The treatment of groin pain is complex and individual, as its causes may vary from patient to patient. Gradual physical therapy combined with pharmacotherapy should be effective in most cases. The latter includes nonsteroid anti-inflammatory drugs and muscle relaxants. A physical therapy programme usually involves stretching and strengthening of adductor muscles, abdominal wall muscles, iliopsoas muscle, quadriceps, and hamstrings. In case that physical therapy and pharmacotherapy fail, surgery is needed, depending on the cause.
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ABSTRACT: Fußball ist eine der weltweit populärsten Sportarten, und Verletzungen sind mit hoher Inzidenz zu finden, wobei bestimmte intrinsische und extrinsische Faktoren eine pathogenetisch wesentliche Rolle spielen. Der Schweregrad von Verletzungen ist meist gering und selbstlimitierend, eine ausgiebige Behandlung oder die Durchführung bildgebender diagnostischer Maßnahmen sind nicht nötig. Die radiologische Untersuchung ist indiziert bei klinisch unklaren Befunden, zur Planung einer etwaigen Arthroskopie oder zur klinisch-prognostischen Einschätzung der Veränderungen. Von den verfügbaren Modalitäten ist die MRT von größter Bedeutung. Verletzungen als Folge des Fußballspielens sind in allen Körperabschnitten zu beobachten, v. a. an den unteren Extremitäten und hier besonders an Knie- und Sprunggelenk. Soccer is one of the most popular sports worldwide. There is a high incidence of injuries in soccer in which several intrinsic and extrinsic factors play a part. Most injuries are minor, self-limiting and do not need extensive medical treatment or imaging. Imaging can be required for several reasons e.g. when the clinical findings are doubtful, to replace arthroscopy (i. e. of the knee) or for prognostic reasons. All imaging modalities available to the radiologist can be used but MRI is the most valuable imaging modality with its superior contrast resolution and multiplanar capabilities. Basically, injuries in the soccer player can occur anywhere in the body like in every sport. The lower extremities, more specific the knee and ankle, are however the most injured parts.Der Radiologe 10/2002; 42(10):778-787. DOI:10.1007/s00117-002-0802-6
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ABSTRACT: Chronic groin pain is a common symptom in the football and hockey codes. Although there is a large differential diagnosis, this review focuses upon the peri-pubic causes of isolated groin pain (pubalgia). Publications that included a hypothesis of the cause of pubalgia were reviewed. The competing views were that pubalgia arises from a single pathology, multiple unrelated pathologies, and multiple interdependent pathologies. An interdependent model is the most practical, in the absence of scientific proof for either paradigm. Posterior inguinal canal deficiency is established as a common finding in male athletes, but it may be asymptomatic. Osteitis pubis and insertional adductor tendinopathy are also both common entities that often are considered to coexist. Overuse in sports involving kicking, sprinting, and changing direction is implicated as a cause of pubalgia by all paradigms. Various surgeries to the pubic region may achieve results by i) correcting a force imbalance at the pubic symphysis and surrounding pubic rami created by abnormal adductor and abdominal muscles; ii) reducing compartment pressures; and iii) enforcing a rest period and gradual resumption of activities.