This pain usually radiates to the adductor muscle region and even the testicles, although it is often difficult for the patient to pinpoint the exact location following sporting activity the person with athletic pubalgia will be stiff and sore. Athletic pubalgia is a painful strain or tear of any soft tissue muscle, tendon, ligament in the lower abdomen or groin area. Proposed algorithm for the management of athletes with athletic. Symptoms include pain during sports movements, particularly hip extension, and twisting and turning. Please refer to some of our other recent articles for other details about these syndromes. The role of imaging modalities in the diagnosis of hip and groin pain, and specifically for athletic pubalgia, continues to evolve. Athletic pubalgia is a clinical syndrome of chronic lower pelvic and groin pain, usually encountered in athletes. The sports hernia has been a subject of debate and confusion for years, even among doctors and physical therapists. It most often occurs during sports that require sudden.
Sports herniaathletic pubalgia has received increasing attention as a source of disability and time lost from athletics. Athletic pubalgia is a general term that encompasses a wide range of injuries at the symphysis pubis that share a similar injury mechanism and clinical presentation of exertional pubic and groin pain 5. Athletic pubalgia has been characterized as chronic groin pain in conjunction with a dilated superficial ring of the inguinal canal. The term athletic pubalgia seems a much better fit than sports hernia since the former term captures the idea of multiple possible afflictions around the pubis and does not connote a likely misleading cause of pain. Athletic pubalgia is a term which includes pubic symphysis tendinous and aponeurotic injuries resulting in chronic exretional pubic and groin pain. Athletic pubalgia reflects injury to one or more pubic structures, which include the pubic symphysis enthesis.
It includes large fieldofview sequences of the bony pelvis as well as smaller fieldofview sequences of the pubic symphysis 36. Athletic pubalgia sports hernia sports medicine today. Previously described in highperformance athletes, ap has also been reported to occur in recreational athletes. The syndrome of athletic pubalgia is common in highperformance athletes. Pelvic mr images of 32 athletes 30 men, 2 women with pubalgia were studied. The present section, to a large degree, represents an update on these articles,8992 in addition to. Request pdf athletic pubalgia athletic pubalgia, or sports hernia, affects people actively engaged in sports. Athletica pubalgia is thought to be a cause of groin pain in athletic people. Diagnosis is made after ruling out the presence of an inguinal hernia. Postural intervention needs to take place in which of the following positions. The open, allsuture repair technique for the treatment of. Jun 11, 2014 athletic pubalgia refers to lower abdominal and groin pain arising from an injury to the congruent fascial sheath of the rectus abdominis and the adductor complex. Sep 27, 2017 pubalgia is a common injury in the groin area.
Myers 8490 patients 5460 operations the concept of the pubic joint rectus abdominus injury with strong pull of adductors with anterior tilt of the pelvis against the lip of the inferior pubic ramus 17 different nonhip, softtissue structures as cause for primary pain meyers ann surg 2008 surgical options open approaches. Complete tearing or displacement can occur unilaterally or across the midline to the other side. Athletic pubalgia refers to lower abdominal and groin pain arising from an injury. Athletic pubalgia surgery medical clinical policy bulletins.
Because different tissues may be affected and a traditional hernia may not exist, the medical community prefers the term athletic pubalgia to refer to this type of injury. The authors concluded that surgical repair of athletic pubalgia in women is successful in. A suggested model for physical examination and conservative. Ap is also a challenge for conservative intervention with randomized controlled trials showing mixed success rates. Eightyeight percent reported that the surgery was a success at followup.
We currently confine the surgical procedure to the injured structures abdominal wall only, adductor tendon only, or both to limit morbidity and expedite recovery. The athlete with athletic pubalgia will often report. Hammoud s, bedi a, magennis e, meyers wc, kelly bt. Description of this condition and its management is scarce in. Some authors consider pubalgia as a pain localized in the pubic symphysis, others as a pain that affects the pubic area in a wider sense involving other anatomical structures including the nonmusculoskeletal structures. Athletic pubalgia sports hernia or gilmores groin sports hernia involves injury to the posterior wall ofthe inguinal canal and can appear as a tear of the transverses abdominis muscle or as a disruption to the conjoined tendon tendon of insertion of the internal oblique and transverses abdominis muscles. Athletes with pubalgia have an imbalance of the adductor and abdominal muscles at the pubis, that leads to an increase of the weakness of the posterior wall of the groin. However, due to the number of potential differential diagnoses for athletes with chronic pain in the groin and lower abdominal region. Proposed algorithm for the management of athletes with. Imaging athletic pubalgia and core muscle injury aspetar. Of the 79 patients with mripositive athletic pubalgia. As a syndrome, ap is difficult to diagnose both with clinical examination and imaging. Sports hernia or athletic pubalgia is a chronic condition which often results from overuse of groin area and repeated trauma. Athletic pubalgia is the most common fixable problem in this group of athletes.
Pubalgia definition of pubalgia by medical dictionary. Groin pain most commonly develops insidiously, but may present acutely with a clinical history of a sudden tearing sensation. Data analysis from medical records of patients with athletic pubalgia. A dedicated athletic pubalgia mri protocol has evolved as the imaging standard for core muscle injuries, particularly if the pathology is felt to be extrinsic to the hip joint. It is very important to underline the enormous importance for proper and early diagnosis. It is a poorly defined condition, for which there is not a consensus regarding the cause andor treatment. David geier is an orthopedic surgeon and sports medicine specialist in charleston, south carolina.
Its cause can be multifactorial, but is mainly an overuse injury from highlevel athletic activity. The main cause of sports hernia athletic pubalgia is the hard and sudden planting of the feet andor twisting of the body at an intense level, usually during sports. In soccer, groin and lower abdominal pain accounts for 10% of injuries per year. Athletic pubalgia, more commonly known as sports hernia, is defined as chronic lower abdominal and groin pain without the presence of a true hernia.
In most cases, patients should absolutely avoid surgery as initial therapy, and instead, these patients should be first referred to a specialist or a rehab program. Treatment with an internal oblique flap reinforced with mesh alleviates symptoms. Sports hernia or athletic pubalgiacausessymptomstreatment. Groin pain in athletes is common, and 1 source of groin pain is athletic pubalgia, or a sports hernia. While most medical professionals prefer to use the terms athletic pubalgia or core muscle injuries to describe this type of injury, the general public tends to be more familiar with the term sports hernia. Athletic pubalgia is a condition of the lower abdominal and inguinal region caused by weakness or tearing of the rectus abdominus insertion to the superior pubic ramus. Its also known as a hockey hernia, gilmores groin, or a sports hernia. Typically athletic pubalgia is believed to be multifaceted, occurring with a twisting motion exacerbated by planting the foot at high speeds, sudden sharp changes in direction, repetitive kicking, and lateral motion. Athletic pubalgia, also called sports hernia, core injury, hockey hernia, hockey groin, gilmores groin, or groin disruption is a medical condition of the pubic joint affecting athletes. A case study samantha johnson background information background information cont surgery athletic pubalgia sometimes identified as sports hernia, a very common diagnosis for a broad spectrum of pathologies. Straining or tearing of any soft tissuemuscle, tendon, or ligamentin the lower abdomen. The underlying problem in athletic pubalgia is a sprain, tear, or avulsion of a muscle or tendon that originates or terminates on the pubic bone.
Recognition, treatment, and prevention article pdf available in athletic training and sports health care 21. Athletic pubalgia most likely is not a result of multiple different injuries, particularly because most of these patients often describe a single inciting injury. Osteitis pubis refers to the osseous changes in the pubic bones secondary to chronic shearing and distracting forces on the unstable pubic symphysis. Two recognized causes of an insidious onset of groin pain in the young adult athlete are core muscle injuryathletic pubalgia cmiap and femoroacetabular impingement fai. Studies are limited, however, lacking consistent objective criteria for making the diagnosis and assessing outcomes. Kicking a soccer ball, shooting a hockey puck, or turning to receive a lacrosse ball are all examples of sports plays that can cause sports hernia. In order to regain balance of the soft tissue, reduced tension of these muscles should be addressed. The dunn view is particularly useful in detecting femoral neck lesions consistent with camtype fai.
High incidence of athle c pubalgia symptoms in professional athletes with symptoma c femoroacetabular impingement. Dec 28, 2012 often overlooked and misdiagnosed, pelvic and groin injuries have ended the career of many athletes. There is no consensus for the etiology of cmiap, although most theories support an overuse syndrome. Historically, athletic pubalgia were female as reported by meyers, but this has changed dramatically over the last two decades, and now approximately 15 % of patients with athletic pubalgia are female. It is increasingly recognized in athletes as a source of groin pain and is often associated with other pathology. It should be noted that there are differences in male versus female anatomy with regard to the pelvis and the hips. To describe the mr findings in athletes with pubalgia. It is either a musculotendinous or osseous injury that involves the insertion of abdominal muscles on the pubis and the upper aponeu.
Sonographic evaluation of athletic pubalgia northwestern. Athletic pubalgia written by john snyder, pt, dpt, ocs, cscs posted on july 6, 2015 january 5, 2019 4 comments in the next installment of the differential diagnosis series for medbridge education, we are going to take a look at the difficult and complex diagnosis of athletic pubalgia. Athletic pubalgia and sports hernia rsna publications online. Surgery for athletic pubalgia has been performed concurrently with treatment of fai, or following fai surgery if symptoms did not resolve. Once the patient has been evaluated by an orthopedic sports medicine surgeon with extensive experience in treating athletic pubalgia, the patient is next evaluated by a general surgeon who also possesses extensive experience in diagnosing and treating this condition. Adductor longus sprains and tears athletic pubalgia hernia and general surgeons will sometimes see these patients, who think maybe they have a hernia or a sports hernia.
Etiology symptoms are often secondary to strain of the muscles that attach in the area e. Oct 03, 20 in fact, the true diagnosis is called athletic pubalgia a synonym for sports hernia. Commonly referred to as sports hernia or osteitis pubis, advances in diagnostic imaging and. Unfortunately, as poor a term as sports hernia may be, we may be stuck with it since the sports. The general public and media are more familiar with sports hernia, however, and this term will be used for the remainder of this article.
A thorough history and a physical examination is needed to differentiate groin strains from athletic pubalgia, osteitis pubis, hernia, hip. N2 athletic pubalgia, or sports hernia, represents a constellation of pathologic conditions occurring at and around the pubic symphysis. Athletic pubalgia is a general term for many of the pubic bonebased muscle or tendon injuries. Prevalence of surgical repair for athletic pubalgia and impact on. It is either a musculotendinous or osseous injury that involves the insertion of abdominal muscles on the pubis and the upper aponeurotic insertion of the adductor muscles. Apr 18, 2012 groin pain is a common complaint in sports involving running, kicking and explosive changes of direction, and as such is frequently encountered by the sports physiotherapist. Commonly referred to as sports hernia or osteitis pubis, advances in. Athletic pubalgia, also known as gilmores groin, sportssportsmans hernia or occult hernia is a condition limited almost exclusively to professional or other highperformance athletes. The internal oblique muscle and external oblique aponeurosis of the internal. Sports herniaathletic pubalgia has received increasing attention as a source of.
However, a largefieldofview magnetic resonance mr imaging survey of the pelvis, combined with highresolution mr imaging of the pubic symphysis, is an excellent means of assessing various causes of athletic pubalgia. Athletic pubalgia ap has been reported to afflict athletes who participate in sports that entail repetitive twisting and turning while moving e. Mr findings in athletes with pubalgia springerlink. Some medical professionals also apply sports hernia to other types of injuries, such as disruptions to the inguinal canal that present.
Feb 12, 2016 core muscle injuryathletic pubalgia is also known as a sports or sportsmans hernia, however, the term hernia may be a misnomer as there is no true protrusion through a defect in the anterior abdominal wall. These muscles and tendons may be part of your abdominal wall or your leg. Medical coverage policy surgery for athletic pubalgia. The dunn view had been particularly useful in detecting femoral head asphericity consistent with the camtype fai. Jun 04, 2018 sports hernia or athletic pubalgia is a chronic condition which often results from overuse of groin area and repeated trauma. The role of femoroacetabular impingement in core muscle. Athletic pubalgia femoral head alpf medical research. Athletic pubalgia and associated rehabilitation europe pmc. Cmiap, or sports hernia, is a syndrome of disabling exertional inguinal and adductor pain commonly seen in highperformance athletes, possibly due to a disruption. Epidemiological profile of patients diagnosed with athletic pubalgia. Both the american academy of orthopedic surgeons aaos and the american orthopedic society for sports medicine aossm use of the term sports hernia to describe only one specific injuryathletic pubalgia. Athletes with a history of ap repair were identified using the nfl combine. Athletic pubalgia is sometimes referred to as a sports hernia. Athletic pubalgia is an important clinical syndrome with complex anatomy primarily involves myotendinous structures about the pubic symphysis some interaction with inguinal canal injury and traditional hernia exists at least 4 injury areas need to be assessed.
Athletic pubalgia is defined as pain in the groin area of an athlete. The right and left medial tendons merge with the anterior pubic. Athletic pubalgia groin pain in an individual that cannot be attributed to hip joint or hip tendon pathology, often in competitive athletes may be acute, but is more often chronic. Inflexible, tight, damaged and weakened hip flexor muscles and inner thigh and groin muscles that stretch the lower abdominal muscles and bend pelvis forward often lead to the gradual development of sports hernia. Previously described in highperformance athletes, it can occur.
Request pdf understanding sports hernia athletic pubalgia. Surgery for athletic pubalgia usually consists in abdominal wall repair combined with routine bilateral adductor tenotomy. Pubalgia is a general term used to describe severe groin and hip pain in the professional athlete. Athletic pubalgia ap is a chronic debilitating syndrome that affects many athletes. Refractory groin pain related to activity is commonly encountered in the sports medicine, orthopaedic surgery, general surgery and now radiology communities. The medial and lateral tendons that arise from the anterior pubis contribute to the common muscle. Pubalgia is a fairly uncommon condition seen chiefly in young athletes, and places a substantial burden on elite players, accounting for 5% to 6% of careerlong injuries. It is characterized by pain around the abdomen, groin, hip or thigh.
Often overlooked and misdiagnosed, pelvic and groin injuries have ended the career of many athletes. However, the term hernia is a misnomer because of the absence of a hernia on physical examination or imaging e. Generally, the athletic pubalgia patient will have either pinpoint or generalized pain in the area of the distal rectus abdominus, at. The syndromes features include disabling lower abdominal and inguinal pain at extremes of exertion. Imaging of athletic pubalgia and core muscle injuries. A diagnosis of athletic pubalgia is based primarily on history, physical exam, and imaging.
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