Sports hernias and athletic pubalgia

Groin injuries are a common occurrence in sport, especially in elite level athletes. Most of these injuries are muscular strains that resolve completely with standard conservative management measures. However, some groin injuries result in a significant loss of playing time and can be a source of persistent pain that limits performance. Over the last 15 years, a subset of athletes with chronic, unremitting groin pain known as sports hernia has become increasingly recognized. These injuries present challenging diagnostic and therapeutic management problems for athletic trainers and physicians because of the broad range of diagnostic possibilities, the subtle physical exam findings, and the anatomic complexity of the lower abdominal and groin region. In this chapter, the clinical presentation, diagnostic evaluation, and treatment options for athletes with a possible sports hernia will be reviewed. The differential diagnosis of athletic groin pain will also be discussed since surgeons who treat these athletes must understand the spectrum of injuries in order to make an accurate diagnosis.