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Abdominal musculature abnormalities as a cause of groin pain in athletes

Inguinal hernias and pubalgia

Division of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina

William C. Meyers, MD

Division of General Surgery, Duke University Medical Center, Durham, North Carolina

Joseph A. Moylan, MD

Division of General Surgery,Duke University Medical Center, Durham, North Carolina

John Lohnes, PA-C

Division of Orthopaedic Surgery,Duke University Medical Center, Durham, North Carolina

Frank H. Bassett, MD

Division of Orthopaedic Surgery,Duke University Medical Center, Durham, North Carolina

William E. Garrett, JR, MD, PhD

Division of Orthopaedic Surgery,Duke University Medical Center, Durham, North Carolina

There has been increasing interest within the European sports medicine community regarding the etiology and treatment of groin pain in the athlete. Groin pain is most commonly caused by musculotendinous strains of the adductors and other muscles crossing the hip joint, but may also be related to abdominal wall abnormalities. Cases may be termed "pubalgia" if physical examination does not reveal inguinal hernia and there is an absence of other etiology for groin pain. We present nine cases of patients who underwent herniorrhaphies for groin pain. Two patients had groin pain without evidence of a hernia preoperatively (pubalgia). In the remaining seven patients we determined the presence of a hernia by physical examination. At operation, eight patients were found to have inguinal hernias. One patient had no hernia but had partial avulsion of the internal oblique fibers from their insertion at the pubic tubercle. The average interval from operation to return to full activity was 11 weeks. All patients returned to full activity within 3 months of surgery. One patient had persistent symp toms of mild incisional tenderness, but otherwise there were no recurrences, complications, or persistence of symptoms. Abnormalities of the abdominal wall, includ ing inguinal hernias and microscopic tears or avulsions of the internal oblique muscle, can be an overlooked source of groin pain in the athlete. Operative treatment of this condition with herniorrhaphy can return the athlete to his sport within 3 months.

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