Athletic pubalgia

Athletic pubalgia, also called the sportman's hernia or sports hernia, Gilmore's groin or groin disruption, is a medical condition of the groin affecting athletes.Ahumada LA, Ashruf S, Espinosa-de-los-Monteros A, Long JN, de la Torre JI, Garth WP, Vasconez LO. "Athletic pubalgia: definition and surgical treatment". "Ann Plast Surg" 2005;55(4):393-6. PMID 16186706] Jerry Gilmore recognized the syndrome in 1980 and developed a surgical repair technique. It is a syndrome characterized by chronic groin pain in athletes and a dilated superficial ring of the inguinal canal. Soccer and Ice Hockey players are affected most frequently, and both recreational and professional athletes may be affected. A hernia cannot be found on physical examination or medical imaging, and is not revealed during surgery. The term hernia thus is a misnomer,Joesting DR. "Diagnosis and treatment of sportsman's hernia". "Curr Sports Med Rep" 2002;1(2):121-4. PMID 12831721] but has persisted, as surgical reconstructions similar to those performed for inguinal hernias are often effective for "sports hernias" as well.

Symptoms include pain during sports movements, particularly hip extension, and twisting and turning. This pain usually radiates to the adductor muscle region and even the testicles, although it is often difficult for the patient to pin-point the exact location.

Following sporting activity the person with athletic pubalgia will be stiff and sore. The day after a football match, getting out of bed or a car will be difficult. Any exertion that increases intra-abdominal pressure, such as coughing, sneezing, or sporting activity can cause pain. In the early stages, the person may be able to continue playing their sport, but the problem usually gets progressively worse.

As pain in the groin and pelvis can be referred from a number of problems, including injuries to the lumbar spine, the hip joint, the sacro-iliac joint, the abdomen, and the genito-urinary system, diagnosis of athletic pubalgia requires skillful differentiation and pubic examination in certain cases where there is intense groin pain.

The diagnosis of Gilmore's groin is based on the patient's history and clinical signs. The most notable clinical sign is dilation of the superficial inguinal ring on the affected side, which can be palpated by the examining doctor when the scrotum is inverted with the little finger. Typically, there is specific pain on coughing and sneezing, as well as sitting up and squeezing the legs together.

The exact lesion may differ, but common pathologic findings at operation are:" [http://www.108harleystreet.co.uk/Pages/gilmore-groin-hernia-clinic.htm The Gilmore Groin & Hernia Clinic] ". Retrieved November 24, 2006.]
* torn external oblique aponeurosis
* tear in the conjoint tendon
* conjoint tendon torn from pubic tubercle
* dehiscence between conjoined tendon and inguinal ligament
* tear in the fascia transversalis
* abnormal insertion of the rectus abdominis muscle
* tear of the abdominal internal oblique muscle from the pubic tubercle
* entrapment of the ilioinguinal nerve or genitofemoral nerveeMedicine|sports|162] Several of these lesions may occur simultaneously. Also, many athletes have concomitant weakness or tearing of the adductor muscles of the hip.

The exact incidence of these entities is unknown: some believe it is the most common cause of chronic groin pain in athletes, while others argue that it is only rare.Fredberg U, Kissmeyer-Nielsen P. "The sportsman's hernia--fact or fiction?" "Scand J Med Sci Sports" 1996;6(4):201-4. PMID 8896091] Conservative therapies (gentle stretching and a short period of restGPNotebook|53477314] ) may temporarily alleviate the pain, but definitive treatment consists of surgical repair followed by a structured rehabilitation.

Notable cases

Well-known sufferers include:
* Kentucky Wildcats guard Jodie Meeks
* Denver Nuggets guard Chucky Atkins
* Patriots quarterback Tom Brady" [http://www.boston.com/sports/football/patriots/articles/2006/01/31/bradys_groin_may_be_hurt/ Brady's groin may be hurt] ". "The Boston Globe", January 31 2006. Retrieved December 3, 2006.]
* San Jose Sharks forwards Jonathan Cheechoo and Devin Setoguchi
* England cricketer Ashley Giles" [http://sport.independent.co.uk/cricket/article1523075.ece Angus Fraser: England play with fire over fitness for Ashes tour] ". "The Independent", 13 September 2006. Retrieved December 3, 2006.]
* Philadelphia Eagles quarterback Donovan McNabbJ Cluett. " [http://orthopedics.about.com/od/famousinjuries/p/dovovanmcnabb.htm Donovan McNabb - Sports Hernia] ". Retrieved December 3, 2006.]
* Outfielders Chris and Shelley Duncan [http://www.stltoday.com/stltoday/sports/stories.nsf/cardinals/story/25754128FF55D8B98625735D000537B6?OpenDocument AP - Chris Duncan undergoes surgery for sports hernia] Retrieved September 22, 2007]
* Los Angeles Galaxy soccer player Benjamin Benditson" [http://web.mlsnet.com/news/mls_events_news.jsp?ymd=20051110&content_id=47956&vkey=mlscup2005&fext=.jsp Los Angeles Galaxy mini bios] ". November 10, 2005. Retrieved December 3, 2006.]
*Houston Dynamo soccer player Joseph Ngwenya
* Kilmarnock F.C. midfielder Danny Invincibile" [http://www.dailyrecord.co.uk/opinion/columnists/sport/billybrown/ Players will put on a United front to get back winning] ". "Daily Record", 17 January 2007. Retrieved January 19, 2007.]
* Toronto Maple Leafs forward Kyle WellwoodSportsline. [http://www.sportsline.com/nhl/players/playerpage/273567 42 Kyle Wellwood, C] . Retrieved March 7, 2007.]
* Philadelphia Flyers forward Daniel BrièreSBR Forum. [http://forum.sbrforum.com/hockey-handicapping/4497-sabres-center-have-surgery-sports-hernia.html Sabres' center to have surgery for sports hernia] . Retrieved March 7, 2007.]
* New York Islanders center Shawn BatesYahoo! Sports. [http://sports.yahoo.com/nhl/news?slug=rotowire-hawnatesoneforegular&prov=rotowire&type=fantasy Shawn Bates: Done for Regular Season] . Retrieved March 7, 2007.]
* Detroit Red Wings forward Darren McCartyNetScape Sports. [http://sports.netscape.com/story/2007/01/31/kobasew-and-mccarty-out-of-action Kobasew and McCarty out of action] . Retrieved March 7, 2007.]
* New England Revolution forward Pat NoonanYahoo! Sports. [http://sports.yahoo.com/mls/news?slug=ap-revolution-noonansurgery&prov=ap&type=lgns Revolution's Noonan to have surgery for sports hernia] . Retrieved March 21, 2007.]
* Nashville Predators winger Jean-Pierre DumontSports Illustrated. [http://sportsillustrated.cnn.com/2005/hockey/nhl/12/02/dumont/?section=si_hockey Sabres' Dumont out with hernia] . Retrieved March 21, 2007.]
* Dallas Stars defenseman Sergei Zubov
* Anaheim Ducks goaltender Jean-Sébastien Giguère and forward Samuel Påhlsson
*Chicago Blackhawks forward Jason Williams " [http://blackhawks.nhl.com/team/app/?service=page&page=NewsPage&articleid=350454"] Retrieved January 18, 2008.]
* Detroit Red Wings forward Tomas HolmströmDetroit Free Press. [http://www.freep.com/apps/pbcs.dll/article?AID=/20080611/BLOG09/80611044/1053/SPORTS05 Holmstrom has surgery for sports hernia] . Retrieved June 12, 2008.]
* Colorado Avalanche forward Joe Sakic
* Texas Rangers second baseman Ian KinslerAssociated Press. [http://sports.espn.go.com/mlb/news/story?id=3541721 Sports hernia forces Rangers' Kinsler to DL, could end his season] . Retrieved August 19, 2008.]
* New Orleans Saints tight end Jeremy Shockey
* Lemoyne College Dolphins center back Davide DiPaola
* Philadelphia Eagles Wide Receiver Kevin Curtis

Footnotes

External links

* [http://www.108harleystreet.co.uk Gilmore Groin and Hernia Clinic]