Skip to main content

Sportsmen Hernia

  • Chapter
  • First Online:
Laparo-endoscopic Hernia Surgery

Abstract

Sportsmen hernia (SH) is one of the least understood, poorly defined, and under-researched maladies to affect the human body and is a leading cause of athletes’ retirement from competitive sports. It is more common in high-level athletes, although it could be also present in active young people. It is an obscure condition of uncertain etiology commonly seen in soccer, football, rugby, and ice hockey players. It reflects a compilation of diagnoses grouped together with a wide range of other pathologies that need to be excluded before this should be considered as a diagnosis. The top five causes for groin pain in athletes have been determined in a recent systematic review 7 [1] and include femoroacetabular impingement (FAI) (32%), athletic pubalgia (24%), adductor-related pathology (12%), inguinal pathology (10%), and labral pathology (5%), with 35% of this labral pathology specifically attributed to FAI.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  1. de Sa D, Hölmich P, Phillips M, Heaven S, Simunovic N, Philippon MJ, et al. Athletic groin pain: a systematic review of surgical diagnoses, investigations and treatment. Br J Sports Med. 2016:1181–6.

    Google Scholar 

  2. Caudill P, Nyland J, Smith C, Yerasimides J, Lach J. Sports hernias: a systematic literature review. Br J Sports Med. 2008;42:954–64.

    Article  CAS  PubMed  Google Scholar 

  3. Minnich JM, Hanks JB, Muschaweck U, Brunt LM, Diduch DR. Sports hernia: diagnosis and treatment highlighting a minimal repair surgical technique. Am J Sports Med. 2011;39(6):1341–9.

    Article  PubMed  Google Scholar 

  4. Meyers WC, McKechnie A, Philippon MJ, Horner MA, Zoga AC, Devon ON. Experience with “sports hernia” spanning two decades. Ann Surg. 2008;248(4):656–65.

    PubMed  Google Scholar 

  5. Meyers WC, Foley DO, Garrett WE, et al. Management of severe lower abdominal or inguinal pain in high-performance athletes. Performing athletes with abdominal or inguinal neuromuscular Pain Study Group (PAIN). Am J Sports Med. 2000;28:2–8. 4

    Article  CAS  PubMed  Google Scholar 

  6. Sheen AJ, Paajanen H. The next step towards rational treatment for ‘The sportsman’s groin. Br J Sports Med. 2015;49(12):764–5.

    Article  PubMed  Google Scholar 

  7. Sheen AJ, Stephenson BM, Lloyd DM, Robinson P, Fevre D, Paajanen H, et al. ‘Treatment of the sportsman’s groin’: British Hernia Society’s 2014 position statement based on the Manchester Consensus Conference. Br J Sports Med. 2014;48(14):1079–87.

    Article  PubMed  Google Scholar 

  8. Fon LJ, Spence RA. Sportsman’s hernia. Br J Surg. 2000;87:545–52.

    Article  CAS  PubMed  Google Scholar 

  9. Holmich P, Dienst M. Differential diagnosis of hip and groin pain. Symptoms and technique for physical examination. Orthopade. 2006;35(1):8. 10–5

    Article  CAS  PubMed  Google Scholar 

  10. Hemingway AE, Herrington L, Blower AL. Changes in muscle strength and pain in response to surgical repair of posterior abdominal wall disruption followed by rehabilitation. Br J Sports Med. 2003;37:54–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Farber AJ, Wilckens JH. Sports hernia: diagnosis and therapeutic approach. J Am Acad Orthop Surg. 2007;15:507–14.

    Article  PubMed  Google Scholar 

  12. Hölmich P, Hölmich LR, Bjerg AM. Clinical examination of athletes with groin pain: an intraobserver and interobserver reliability study. Br J Sports Med. 2004;38(4):446–51.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Lilly MC, Arregui ME. Ultrasound of the inguinal floor for evaluation of hernias. Surg Endosc. 2002;16(4):659–62.

    Article  CAS  PubMed  Google Scholar 

  14. Lorenzini C, Sofia L, Pergolizzi FP, Trovato M. The value of diagnostic ultrasound for detecting occult inguinal hernia in patients with groin pain. Chir Ital. 2008;60(6):813–7.

    PubMed  Google Scholar 

  15. Orchard JW, Read JW, Neophyton J, Garlick D. Groin pain associated with ultrasound finding of inguinal canal posterior wall deficiency in Australian Rules footballers. Br J Sports Med. 1998;32:134–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Depasquale R, Landes C, Doyle G. Audit of ultrasound and decision to operate in groin pain of unknown aetiology with ultrasound technique explained. Clin Radiol. 2009;64(6):608–14.

    Article  CAS  PubMed  Google Scholar 

  17. Barile A, Erriquez D, Cacchio A, De Paulis F, Di Cesare E, Masciocchi C. Groin pain in athletes: role of magnetic resonance. Radiol Med (Torino). 2000;100(4):216–22.

    CAS  Google Scholar 

  18. Paajanen H, Hermunen H, Karonen J. Pubic magnetic resonance imaging findings in surgically and conservatively treated athletes with osteitis pubis compared to asymptomatic athletes during heavy training. Am J Sports Med. 2008;36(1):117–21.

    Article  PubMed  Google Scholar 

  19. Kuikka L, Hermunen H, Paajanen H. Effect of pubic bone marrow edema on recovery from endoscopic surgery for athletic pubalgia. Scand J Med Sci Sports. 2015;25(1):98–103. https://doi.org/10.1111/sms.12158. Epub 2013 Dec 18.

    Article  PubMed  CAS  Google Scholar 

  20. Garvey JF. Computed tomography scan diagnosis of occult hernia. Hernia. 2012;16:307–14.

    Article  CAS  PubMed  Google Scholar 

  21. Swan KG Jr, Wolcott M. The athletic hernia: a systematic review. Clin Orthop Relat Res. 2007;455:78–87.

    Article  PubMed  Google Scholar 

  22. Jansen JA, Mens JM, Backx FJ, Kolfschoten N, Stam HJ. Treatment of longstanding groin pain in athletes: a systematic review. Scand J Med Sci Sports. 2008;18:263–74.

    Article  CAS  PubMed  Google Scholar 

  23. Hölmich P, Uhrskou P, Ulnits L, et al. Effectiveness of active physical training as treatment for long-standing adductor – related groin pain in athletes: randomised trial. Lancet. 1999;353:439–43.

    Article  PubMed  Google Scholar 

  24. Comin J, Obaid H, Lammers G, Moore J, Wotherspoon M, Connell D. Radiofrequency denervation of the inguinal ligament for the treatment of ‘Sportsman’s Hernia’: a pilot study. Br J Sports Med. 2013;47:380–6.

    Article  PubMed  Google Scholar 

  25. King E, Ward J, Small L, Falvey E, Franklyn-Miller A. Athletic groin pain: a systematic review and meta-analysis of surgical versus physical therapy rehabilitation outcomes. Br J Sports Med. 2015;49(22):1447–51.

    Article  CAS  PubMed  Google Scholar 

  26. Paajanen H, Brinck T, Hermunen H, Airo I. Laparoscopic surgery for chronic groin pain in athletes is more effective than nonoperative treatment: a randomized clinical trial with magnetic resonance imaging of 60 patients with sportsman’s hernia (athletic pubalgia). Surgery. 2011;150:99–107.

    Article  PubMed  Google Scholar 

  27. Boyle J, Withers K, Singer KP. Prevention of groin injuries in the elite Australian rules footballer – 8 year clinical perspective. Manuelle Therapie. 2008;12:131–5.

    Article  Google Scholar 

  28. Moeller JL. Sportsman’s hernia. Curr Sports Med Rep. 2007;6(2):111–4.

    PubMed  Google Scholar 

  29. Kaplan O, Arbel R. Sportsman’s hernia – a plea for conservative therapeutical approach. Harefuah. 2005;144(5):351–6. 381

    PubMed  Google Scholar 

  30. Steele P, Annear P, Grove JR. Surgery for posterior inguinal wall deficiency in athletes. J Sci Med Sport. 2004;7:415–21.

    Article  CAS  PubMed  Google Scholar 

  31. Šebečić B, Japjec M, Janković S, Čuljak V, Dojčinović B, Starešinić M. Is chronic groin pain a Bermuda triangle of sports medicine? Acta Clin Croat. 2014;53(4):471–8.

    PubMed  Google Scholar 

  32. Rossidis G, Perry A, Abbas H, Motamarry I, Lux T, Farmer K, et al. Laparoscopic hernia repair with adductor tenotomy for athletic pubalgia: an established procedure for an obscure entity. Surg Endosc. 2015;29(2):381–6.

    Article  PubMed  Google Scholar 

  33. Mei-Dan O, Lopez V, Carmont MR, McConkey MO, Steinbacher G, Alvarez PD, et al. Adductor tenotomy as a treatment for groin pain in professional soccer players. Orthopedics. 2013;36(9):e1189–97.

    Article  PubMed  Google Scholar 

  34. Messaoudi N, Jans C, Pauli S, Van Riet R, Declercq G, Van Cleemput M. Surgical management of sportsman’s hernia in professional soccer players. Orthopedics. 2012;35(9):e1371–5.

    Article  PubMed  Google Scholar 

  35. Jans C, Messaoudi N, Pauli S, Van Riet RP, Declercq G. Results of surgical treatment of athletes with sportsman’s hernia. Acta Orthop Belg. 2012;78(1):35–40.

    PubMed  Google Scholar 

  36. Atkinson HD, Johal P, Falworth MS, Ranawat VS, Dala-Ali B, Martin DK. Adductor tenotomy: its role in the management of sports-related chronic groin pain. Arch Orthop Trauma Surg. 2010;130(8):965–70.

    Article  PubMed  Google Scholar 

  37. Maffulli N, Loppini M, Longo UG, Denaro V. Bilateral mini-invasive adductor tenotomy for the management of chronic unilateral adductor longus tendinopathy in athletes. Am J Sports Med. 2012 Aug;40(8):1880–6.

    Article  PubMed  Google Scholar 

  38. Ingoldby CJ. Laparoscopic and conventional repair of groin disruption in sportsmen. Br J Surg. 1997;84:1171–2.

    Article  Google Scholar 

  39. Susmallian S, Ezri T, Elis M, Warters R, Charuzi I, Muggia-Sullam M. Laparoscopic repair of “sportsman’s hernia” in soccer players as treatment of chronic inguinal pain. Med Sci Monit. 2004;10:52–4.

    Google Scholar 

  40. Srinivasan A, Schuricht A. Long-term follow-up of laparoscopic preperitoneal hernia repair in professional athletes. J Laparoendosc Adv Surg Tech A. 2002;12:101–6.

    Article  PubMed  Google Scholar 

  41. van Veen RN, de Baat P, Heijboer MP, Kazemier G, Punt BJ, Dwarkasing RS, et al. Successful endoscopic treatment of chronic groin pain in athletes. Surg Endosc. 2007;21:189–93.

    Article  PubMed  Google Scholar 

  42. Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009;13(4):343–403.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Miserez M, Peeters E, Aufenacker T, Bouillot JL, Campanelli G, Conze J, et al. Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2014;18(2):151–63.

    Article  CAS  PubMed  Google Scholar 

  44. Bittner R, Arregui ME, Bisgaard T, Dudai M, Ferzli GS, Fitzgibbons RJ, et al. Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS)]. Surg Endosc. 2011;25(9):2773–843.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Bittner R, Montgomery MA, Arregui E, Bansal V, Bingener J, Bisgaard T, et al. Update of guidelines on laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia (International Endohernia Society). Surg Endosc. 2015;29(2):289–321.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Poelman MM, van den Heuvel B, Deelder JD, Abis GS, Beudeker N, Bittner RR, et al. EAES consensus development conference on endoscopic repair of groin hernias. Surg Endosc. 2013;27(10):3505–19.

    Article  CAS  PubMed  Google Scholar 

  47. Genitsaris M, Goulimaris I, Sikas N. Laparoscopic repair of groin pain in athletes. Am J Sports Med. 2004;32:1238–42.

    Article  PubMed  Google Scholar 

  48. Harmon KG. Evaluation of groin pain in athletes. Curr Sports Med Rep. 2007;6:354–61.

    PubMed  Google Scholar 

  49. Paajanen H, Montgomery A, Simon T, Sheen AJ. Systematic review: laparoscopic treatment of long-standing groin pain in athletes. Br J Sports Med. 2015;49(12):814–8.

    Article  PubMed  Google Scholar 

  50. Śmietański M, Śmietańska IA, Modrzejewski A, Simons MP, Aufenacker TJ. Systematic review and meta-analysis on heavy and lightweight polypropylene mesh in Lichtenstein inguinal hernioplasty. Hernia. 2012;16(5):519–28.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Salvador Morales-Conde .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer-Verlag GmbH Germany, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Morales-Conde, S., Dudai, M., Koch, A. (2018). Sportsmen Hernia. In: Bittner, R., Köckerling, F., Fitzgibbons, Jr., R., LeBlanc, K., Mittal, S., Chowbey, P. (eds) Laparo-endoscopic Hernia Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-55493-7_19

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-55493-7_19

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-55491-3

  • Online ISBN: 978-3-662-55493-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics