View source for Athletic pubalgia

{{CMG}}



'''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<ref name=pubalgia>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</ref>. [[Jerry Gilmore]] recognized the [[syndrome]] in 1980 and developed a [[surgery|surgical]] repair technique. It is a syndrome characterized by chronic [[Inguinodynia|groin pain]] in athletes and a dilated [[Superficial inguinal ring|superficial ring]] of the [[inguinal canal]]. [[Soccer]] 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<ref name=joesting>Joesting DR. "Diagnosis and treatment of sportsman's hernia". ''Curr Sports Med Rep'' 2002;'''1(2)''':121-4. PMID 12831721</ref>, 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 [[pathology|pathologic]] findings at operation are <ref name="Harley">"[http://www.108harleystreet.co.uk/Pages/gilmore-groin-hernia-clinic.htm The Gilmore Groin & Hernia Clinic]". Retrieved November 24, 2006.</ref> :
* torn [[Aponeurosis of the Obliquus externus abdominis|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 <ref name=joesting/>
* 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 nerve]]<ref name="eMedicine">{{eMedicine|sports|162}}</ref>
Several of these lesions may occur simultaneously. Also, many athletes have concomitant weakness or tearing of the [[adductor muscles of the hip]].<ref name="Harley">

The exact [[incidence (epidemiology)|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.<ref name=fiction>Fredberg U, Kissmeyer-Nielsen P. "The sportsman's hernia--fact or fiction?" ''Scand J Med Sci Sports'' 1996;'''6(4)''':201-4. PMID 8896091</ref> Conservative therapies (gentle [[stretching]] and a short period of rest<ref name=GPnotebook>{{GPNotebook|53477314}}</ref>) may temporarily alleviate the pain, but definitive treatment consists of surgical repair followed by a structured rehabilitation<ref name="Harley"/><ref name="eMedicine"/>.

==Notable cases==
Well-known sufferers include:
* Kentucky Wildcats Guard Jodie Meeks
* Denver Nuggets Guard Chucky Atkins
* [[New England Patriots|Patriots]] [[quarterback]] [[Tom Brady]]<ref name="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.</ref>
* [[San Jose Sharks]] forward [[Jonathan Cheechoo]]
* [[English cricket team|England]] [[cricketer]] [[Ashley Giles]]<ref name="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.</ref>
* [[Philadelphia Eagles]] quarterback [[Donovan McNabb]]<ref name=McNabb>J Cluett. "[http://orthopedics.about.com/od/famousinjuries/p/dovovanmcnabb.htm Donovan McNabb - Sports Hernia]". Retrieved December 3, 2006.</ref>
* [[Outfielder|Outfielders]] [[Chris Duncan|Chris]] and [[Shelley Duncan]]<ref name="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</ref>
* [[Los Angeles Galaxy]] [[soccer]] player [[Benjamin Benditson]]<ref name=Galaxy>"[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.</ref>
*[[Houston Dynamo]] [[soccer]] player [[Joseph Ngwenya]]
* [[Kilmarnock F.C.]] midfielder [[Danny Invincibile]]<ref name=Invincibile>"[http://www.dailyrecord.co.uk/opinion/columnists/sport/billybrown/ Players will put on a United front to get back winning]". ''[[Daily Record (Scotland)|Daily Record]]'', [[17 January]] [[2007]]. Retrieved January 19, 2007.</ref>
* [[Toronto Maple Leafs]] forward [[Kyle Wellwood]]<ref name=Wellwood>Sportsline. [http://www.sportsline.com/nhl/players/playerpage/273567 42 Kyle Wellwood, C]. Retrieved March 7, 2007.</ref>
* [[Philadelphia Flyers]] forward [[Daniel Briere]]<ref name=Briere>SBR 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.</ref>
* [[New York Islanders]] [[Centre (ice hockey)|center]] [[Shawn Bates]] <ref name=Bates>Yahoo! Sports. [http://sports.yahoo.com/nhl/news?slug=rotowire-hawnatesoneforegular&prov=rotowire&type=fantasy Shawn Bates: Done for Regular Season]. Retrieved March 7, 2007.</ref>
* [[Detroit Red Wings]] forward [[Darren McCarty]] <ref name=McCarty>NetScape 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.</ref>
* [[New England Revolution]] forward [[Pat Noonan]] <ref name=Noonan>Yahoo! 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.</ref>
* [[Nashville Predators]] winger [[J.P. Dumont]] <ref name=Dumont>Sports Illustrated. [http://sportsillustrated.cnn.com/2005/hockey/nhl/12/02/dumont/?section=si_hockey Sabres' Dumont out with hernia]. Retrieved March 21, 2007.</ref>
* [[Dallas Stars]] defenseman [[Sergei Zubov]]
* [[Anaheim Ducks]] goaltender [[Jean-Sebastien Giguere]] and forward [[Samuel Pahlsson]]
*[[Chicago Blackhawks]] forward [[Jason Williams (ice hockey)|Jason Williams]] <ref name=Williams> "[http://blackhawks.nhl.com/team/app/?service=page&page=NewsPage&articleid=350454"]Retrieved January 18, 2008.</ref>

==External links==
[http://www.herniasymptoms.org/sports-hernia-symptoms-treatment.html Sports Hernia Symptoms]University of Colorado Running Back Brian Lockridge

==Notes==
{{reflist|2}}
[[Category:Sports medicine]]

[[fr:Pubalgie]]

{{jb1}}

{{WH}}
{{WS}}