Athletic Pubalgia

Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, United States
Annals of Plastic Surgery (Impact Factor: 1.49). 11/2005; 55(4):393-6. DOI: 10.1097/
Source: PubMed


Athletic pubalgia, or "sports hernia," affects people actively engaged in sports. Previously described in high-performance athletes, it can occur in recreational athletes. It presents with inguinal pain exacerbated with physical activity. Examination reveals absence of a hernia with pubic point tenderness accentuated by resisted adduction of the hip. Diagnosis is by history and physical findings. Treatment with an internal oblique flap reinforced with mesh alleviates symptoms.
A retrospective review from December 1998 to November 2004 for patients with athletic pubalgia who underwent operative repair was performed. Descriptive variables included age, gender, laterality, sport, time to presentation, outcome, anatomy, and length of follow-up.
Twelve patients, 1 female, with median age 25 years were evaluated. Activities included running (33%), basketball (25%), soccer (17%), football (17%), and baseball (8%). The majority were recreational athletes (50%). Median time to presentation was 9 months, with a median 4 months of follow-up. The most common intraoperative findings were nonspecific attenuation of the inguinal floor and cord lipomas. All underwent open inguinal repair, with 9 being reinforced with mesh. Four had adductor tenotomy. Results were 83.3% excellent and 16.7% satisfactory. All returned to sports.
Diagnosis of athletic pubalgia can be elusive, but is established by history and physical examination. It can be found in recreational athletes. An open approach using mesh relieves the pain and restores activity.

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    • "It has become clear that few of these patients have hernias. Athletic pubalgia is an injury to the myotendinous structures adjacent to the symphysis pubis that stabilize the anterior pelvis.2,35,36,45,67 Meyer et al reported at least 17 separate clinical syndromes that fall under the umbrella of athletic pubalgia.37 "
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    ABSTRACT: A normally functioning hip joint is imperative for athletes who use their lower extremities with running, jumping, or kicking activities. Sports-related injuries of the hip and groin are far less frequent than injuries to the more distal aspect of the extremity, accounting for less than 10% of lower extremity injuries. Despite the lower incidence, hip and groin injuries can lead to significant clinical and diagnostic challenges related to the complex anatomy and biomechanical considerations of this region. Loads up to 8 times normal body weight have been documented in the joint in common daily activities, such as jogging, with significantly greater force expected during competitive athletics. Additionally, treatment for hip and groin injuries can obviate the participation of medical and surgical specialties, with a multidisciplinary approach frequently required. Delay in diagnosis and triage of these injuries may cause loss of time from competition and, potentially, early onset of degenerative changes. Magnetic resonance imaging (MRI) of the hip has proven to be the gold standard for the diagnosis of sports-related hip and groin injuries in the setting of negative radiographs. With its exquisite soft tissue contrast, multiplanar capabilities, and lack of ionizing radiation, MRI is unmatched in the noninvasive diagnosis of intra-articular and extra-articular pathology, as well as intraosseous processes. This review focuses on MRI of common athletic injuries of the hip and groin, including acetabular labral tears, femoral acetabular impingement syndrome, muscle injuries around the hip and groin (including athletic pubalgia), and athletic osseous injuries.
    Sports Health A Multidisciplinary Approach 05/2010; 2(3):252-61. DOI:10.1177/1941738110366699
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    • "disruption), rectus abdominus injury, osteitis pubis, and adductor-related muscle and tendon injury. The term athletic pubalgia has been used to describe inguinal pain with exertion without exam findings of a hernia, which can occur in recreational and elite athletes [72]. This clinical diagnosis is composed of two basic posterior abdominal wall abnormalities, sports hernias and groin disruptions. "
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    ABSTRACT: Muscle injury and strains are very common among athletes. MR is the preferred method of evaluation because of superior contrast resolution, reproducibility, and excellent anatomic detail. Ultrasound is also useful and advocated by some as a front line diagnostic modality because of its lower costs and portability particularly in experienced hands. It is important to remember that injury usually occurs at the myotendinous junction, which may be intramuscular in the hamstring and quadriceps muscles. The size of injury and relationship to the myotendinous junction can provide prognostic information regarding convalescent period, which can be extremely important for the elite athlete. Literature on prognostication is limited and probably results from relative commonality and mild nature of most injuries but further studies are warranted as injuries could affect different sporting population more than others. Future developments regarding treatment will become more important and analysis and classification of imaging finding may provide better prognostication. For example, some have identified the importance of the COX pathway for muscle injury healing and possible deleterious effects of inhibitors (ie, nonsteroidal anti-inflammatory drugs) [137]. Others have experimentally shown the introduction of relaxin growth factor via gene therapy promotes muscle healing [138,139]. With new treatments on the horizon it is important to have supportive objective and accurate information regarding extent and types of injury to help stratify treatment groups and improve patient care. Precise reporting of the location of muscle and tendon injuries is needed, as prognosis may be different. Therefore continued evaluation and classification of muscle and tendon injury with imaging, such as MRI, particularly for the elite athlete should be performed.
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