Definition
Groin pain in athletes
- secondary to tear in external oblique fascia
Epidemiology
Sports with aggressive adduction
- hockey / soccer
Pathology
Tears in external oblique fascia
- tend to be central
- around spermatic cord and ilioinguinal nerve
- pain may be from nerve entrapment
DDx
Adductor Longus Tear
Osteitis Pubis
Hip pathology
NHx
Adductor longus tears
- get better with time
- rarely need surgery
- pain stays below goin
Sports Hernia
- may have nerve / ilioinguinal symptoms
- above groin
- often get worse
Examination
Adductor longus tears
- tender over tendon
- pain / weakness on resisted adduction
Sports hernia
- tender over inguinal ring
- may have palpable dilatation of external inguinal ring
- pain with resisted sit up
- pain with resisted leg flexion
Dynamic ultrasound
May be useful in very experienced hands
MRI
Can be difficult to see
Is often a clinical diagnosis
Management
Non Operative
Rest
Exclude other diagnosis
Operative
Hernia repair
Technique
- expose external oblique fascia
- identify and protect spermatic cord
- identify tears / pathology
- release ilioinguinal nerve
- repair primarily or with gortex mesh
Ilioinguinal nerve
- some surgeons cut the nerve
- risk neuroma
- suprapubic numbness only
Can combine with adductor tenotomy