Myers 8490 patients 5460 operations the concept of the pubic joint rectus abdominus injury with strong pull of adductors with anterior tilt of the pelvis against the lip of the inferior pubic ramus 17 different nonhip, softtissue structures as cause for primary pain meyers ann surg 2008 surgical options open approaches. Typically athletic pubalgia is believed to be multifaceted, occurring with a twisting motion exacerbated by planting the foot at high speeds, sudden sharp changes in direction, repetitive kicking, and lateral motion. Because different tissues may be affected and a traditional hernia may not exist, the medical community prefers the term athletic pubalgia to refer to this type of injury. However, a largefieldofview magnetic resonance mr imaging survey of the pelvis, combined with highresolution mr imaging of the pubic symphysis, is an excellent means of assessing various causes of athletic pubalgia.
Recognition, treatment, and prevention article pdf available in athletic training and sports health care 21. In soccer, groin and lower abdominal pain accounts for 10% of injuries per year. Athletic pubalgia is a general term for many of the pubic bonebased muscle or tendon injuries. Athletic pubalgia, also called sports hernia, core injury, hockey hernia, hockey groin, gilmores groin, or groin disruption is a medical condition of the pubic joint affecting athletes. Mri evaluation of the sportsmans hernia and associated causes of athletic pubalgia adam c. Many athletes with a diagnosis of sports hernia or. Surgical treatment of athletic pubalgia also known as gilmores groin, osteitis pubis, pubic inguinal pain syndrome, inguinal disruption, slap shot gut, sportsmens groin, footballers groin injury complex, hockey groin syndrome, athletic. The appearance of hyperlinks does not constitute endorsement by the defense. Athletic pubalgia ap refers to a syndrome of disabling lower abdominal and inguinal exertional pain with progression to include adductor pain in highperformance athletes. Athletic pubalgia and associated rehabilitation semantic scholar. Kicking a soccer ball, shooting a hockey puck, or turning to receive a lacrosse ball are all examples of sports plays that can cause sports hernia.
However, improved knowledge of anatomic structures, pathophysiologic changes, and clinical findings associated with athletic pubalgia has resulted in improved imaging techniques. It is either a musculotendinous or osseous injury that involves the insertion of abdominal. Postoperative rehabilitation of athletic pubalgia in baseball outfielder matthew kalies, ats and shawn felton, edd, atc, lat this case report is on a professional baseball outfielder who sustained an athletic pubalgia injury. The current case reflects the failure to distinguish pubalgia from lumbar radiculopathy. The term athletic pubalgia seems a much better fit than sports hernia since the former term captures the idea of multiple possible afflictions around the pubis and does not connote a likely misleading cause of pain. Aug 30, 2019 athletic pubalgia sports hernia pdf many athletes with a diagnosis of sports hernia or athletic pubalgia have a spectrum of related pathologic conditions resulting from. Sportsrelated groin pain, commonly known as athletic pubalgia or sports hernia, is characterized by disabling activitydependent lower abdominal and groin pain that is not attributable to any other cause.
In addition to athletic pubalgia and core muscle injury the preferred medical terms, the condition is also known as gilmores groin and slap shot gut. Athletic pubalgia sports hernia pdf many athletes with a diagnosis of sports hernia or athletic pubalgia have a spectrum of related pathologic conditions resulting from. Unfortunately, as poor a term as sports hernia may be, we may be stuck with it since the sports. Shoulderpost gadolinium indirect mr arthrogram inject standard dose of iv contrast and wait 20 minutes before scanning 3. Surgery for athletic pubalgia has been performed concurrently with treatment of fai, or following fai surgery if symptoms did not. Frequently called sports hernia or athletic pubalgia, many surgeons continue to refute the diagnosis because there is a lack of consensus and clear comprehension of the basic pathophysiologic features of this groin pain syndrome. It is considered an overuse injury predisposing to.
Inflexible, tight, damaged and weakened hip flexor muscles and inner thigh and groin muscles that stretch the lower abdominal muscles and bend pelvis forward often lead to the gradual development of sports hernia. A suggested model for physical examination and conservative. Despite the prevalence of the condition, the literature is filled with varying causes, anatomy involved, and terminology. Core injury, core muscle injury, athletic pubalgia. Surgery for athletic pubalgia usually consists in abdominal wall repair combined with routine bilateral adductor tenotomy. Background athletic pubalgia, a term that has gained acceptance over sports hernia, is more common in men than women. In order to regain balance of the soft tissue, reduced tension of these muscles should be addressed. Pubalgia osteitis pubis is a collective term that refers to disorders causing chronic pubic pain. Sports hernia or athletic pubalgiacausessymptomstreatment. A variety of other terms have been used interchangeably to describe this condition including sportsmans hernia, hockey groin, and athletic pubalgia. Athletic injuries, education, diagnostic procedure, ultrasound, mr, ct, musculoskeletal system, musculoskeletal soft tissue, anatomy doi.
Frequently called sports hernia or athletic pubalgia. Pdf athletic pubalgia is a term grossly misunderstood throughout the sports medicine community. Both the american academy of orthopedic surgeons aaos and the american orthopedic society for sports medicine aossm use of the term sports hernia to describe only one specific injuryathletic pubalgia. Studies are limited, however, lacking consistent objective criteria for making the diagnosis and assessing outcomes.
This pain tends to be deeper and more intense than an adductor or iliopsoas strain and is ipsilateral in nature. Athletic pubalgia sports hernia or gilmores groin sports hernia involves injury to the posterior wall ofthe inguinal canal and can appear as a tear of the transverses abdominis muscle or as a disruption. It is a syndrome characterized by chronic groin pain in athletes and a dilated superficial ring of the inguinal canal. Athletic pubalgia groin pain in an individual that cannot be attributed to hip joint or hip tendon pathology, often in competitive athletes may be acute, but is more often chronic. The underlying problem in athletic pubalgia is a sprain, tear, or avulsion of a muscle or tendon that originates or terminates on the pubic bone. Athletic pubalgia was diagnosed on physical examination by a sports physician and a surgeon and confirmed by at least one imaging technique showing injury to the abdominal wall attachment site andor adductors. Jun 04, 2018 sports hernia or athletic pubalgia is a chronic condition which often results from overuse of groin area and repeated trauma. To evaluate the clinical and epidemiological characteristics of pubalgia in patients from a sports medicine center. A diagnosis of athletic pubalgia is based primarily on history. The general public and media are more familiar with sports hernia, however, and this term will be used for the remainder of this article. Athletic training and sports health care athletic pubalgia is a term grossly misunderstood throughout the sports medicine community.
It most often occurs during sports that require sudden changes of direction or intense twisting movements. Groin pain is a common entity in athletes, particularly those engaged in sports that require specific use or overuse of lower abdominal muscles and the proximal musculature of the thigh eg, soccer, ice hockey, australian rules football. These muscles and tendons may be part of your abdominal wall or your leg. Sports hernia athletic pubalgia a sports hernia is a painful, soft tissue injury that occurs in the groin area. Sports herniaathletic pubalgia has received increasing attention as a source of disability and time lost from athletics. Ap is also a challenge for conservative intervention with randomized controlled trials showing mixed success rates. Athletic pubalgia is a clinical syndrome of chronic lower pelvic and groin pain, usually encountered in athletes. For the most part, the term sports hernia encompasses two patterns of injury. The focus is on the core muscle injuries athletic pubalgia or sports hernia. Athletic pubalgia surgery medical clinical policy bulletins.
The main cause of sports hernia athletic pubalgia is the hard and sudden planting of the feet andor twisting of the body at an intense level, usually during sports. Athletic pubalgia is a painful strain or tear of any soft tissue muscle, tendon, ligament in the lower abdomen or groin area. Athletica pubalgia is thought to be a cause of groin pain in athletic people. Athletic pubalgia sports hernia clinics in sports medicine. You may also hear the terms athletic pubalgia ap or inguinal disruption id used to describe the injury. Athletic pubalgia, also known as sports hernia, is a syndrome of chronic lower. Athletic pubalgia is increasingly recognized as a common cause of chronic groin and adductor pain in athletes. Athletic pubalgia misdiagnosed as lumbar radiculopathy a. Athletic pubalgia is a strain or tear of any soft tissue muscle, tendon, ligament. The term athletic pubalgia is used to describe the disruption andor separation of the more medial common aponeurosis from the pubis, usually with some degree of adductor tendon. Apr 18, 2012 groin pain is a common complaint in sports involving running, kicking and explosive changes of direction, and as such is frequently encountered by the sports physiotherapist. Sports hernia or athletic pubalgia is a chronic condition which often results from overuse of groin area and repeated trauma. This syndrome is multifaceted and lacks true definition. Surgery for athletic pubalgia has been performed concurrently with treatment of fai, or following fai surgery if symptoms did not resolve.
Athletic pubalgia ap has been reported to afflict athletes who participate in sports that entail repetitive twisting and turning while moving e. Treatment protocols for sports hernia remain controversial. Any information contained in this pdf file is automatically generated from digital material submitted to epos by third parties in the form of scientific presentations. A retrospective single center study on 27 patients who underwent surgery for athletic pubalgia was conducted by kajetanek et al. Microsoft powerpoint pri in the athletic training room. The term athletic pubalgia seems a much better fit than sports hernia since the former term captures the idea of multiple possible afflictions around the pubis and does not connote a likely misleading. Athletic pubalgia, more commonly known as sports hernia, is defined as chronic lower abdominal and groin pain without the presence of a true hernia. References to any names, marks, products, or services of third parties or hypertext links to third. The physical examination for sports hernia athletic pubalgia begins with palpation of the potential sites of injury. Imaging of athletic pubalgia and core muscle injuries. It is characterized by pain around the abdomen, groin, hip or thigh.
Athletic pubalgia, a term proposed as an alternative to sports hernia,simply describes the presence of pain around the pubic bone in athletes 4. Athletic pubalgia written by john snyder, pt, dpt, ocs, cscs posted on july 6, 2015 january 5, 2019 4 comments in the next installment of the differential diagnosis series for medbridge education, we are going to take a look at the difficult and complex diagnosis of athletic pubalgia. Mri evaluation of the sportsmans hernia and associated. Epidemiological profile of patients diagnosed with athletic pubalgia. On 24 of the 119 mris, the valsalva maneuver either revealed the finding or made it significantly more apparent. Myers 8490 patients 5460 operations the concept of the pubic joint rectus abdominus injury with strong pull of adductors with anterior tilt of the pelvis against the lip of the inferior pubic. Medical coverage policy surgery for athletic pubalgia. Athletic pubalgia and associated rehabilitation europe pmc. Athletic pubalgia is sometimes referred to as a sports hernia. The underlying problem in athletic pubalgia is a sprain, tear, or avulsion of a muscle or tendon. Jul 14, 2019 athletic pubalgia sports hernia pdf many athletes with a diagnosis of sports hernia or athletic pubalgia have a spectrum of related pathologic conditions resulting from.
The understanding of what causes athletic pubalgia continues to evolve. Some practitioners advise nonsurgical treatments such as rest, antiinflammatory medications, and physical therapy. Both the american academy of orthopedic surgeons aaos and the american orthopedic society for sports medicine aossm use of the term sports hernia to describe only one specific injury athletic pubalgia. Athletic pubalgia is a painful complex syndrome encountered by many athletes involved in sports. The hallmark complaint of athletic pubalgia is a deep groin or lower abdominal pain with exertion. Of the 79 patients with mripositive athletic pubalgia. Athletic pubalgia is more common in males due to a narrower pelvis that cause greater shifts in force and less stability than the wider female pelvis.
Athletic pubalgia is an umbrella term for career ending, or qualityoflifethreatening, musculoskeletal injuries involving attachments andor soft tissue support structures. Athletic pubalgia involves a wide variety of structures surrounding the pelvis and often results in cessation of physical activity. It is a poorly defined condition, for which there is not a consensus regarding the cause andor treatment. Since the original report of gilmores groin in 1980, sports herniaathletic pubalgia has received increasing attention as a source of disability and time lost from. Previously described in highperformance athletes, ap has also been reported to occur in recreational athletes. While this term avoids any implicit bias, it is a nonspecific. Groin pain is a common complaint in sports involving running, kicking and explosive changes of direction, and as such is frequently encountered by the sports physiotherapist. It is either a musculotendinous or osseous injury that involves the insertion of abdominal muscles on the pubis and the upper aponeu. During resisted hip flexion and adduction, there may be tearing at the insertion point of the. Nonpalpable, small direct and indirect hernias microscopic tears or avulsions of the intenal oblique muscle torn external oblique aponeurosis torn conjoined tendons thinning of the transversalis fascia entrapment of the ilioinguinal nerve athletic pubalgia. Lower abdominal, adductor, and symphyseal pain to palpation is common in athletes. Straining or tearing of any soft tissuemuscle, tendon, or ligamentin the lower abdomen.
Pubalgia osteitis pubis includes osteitis pubis and athletic pubalgia, which are overuse conditions involving. The goal is to raise awareness about the variety of injuries that occur and therapeutic options. Athletic pubalgia, also known as gilmores groin, sportssportsmans hernia or occult hernia is a condition limited almost exclusively to professional or other highperformance athletes. The current case reflects the failure to distinguish pubalgia. Postoperative rehabilitation of athletic pubalgia in. An increasingly recognized cause of chronic groin pain in athletes is athletic pubalgia ap. One cause of groin pain in athletic patients may be a core muscle injury, commonly referred to as sports hernia. We currently confine the surgical procedure to the injured structures abdominal wall only, adductor tendon only, or both to limit morbidity and expedite recovery. Postural intervention needs to take place in which of the following positions. Athletic pubalgia is a syndrome that encompasses a wide list of injuries involving attachment disruption and instability. Pubalgia usually refers to pain in the groin or lower abdominal area, typically in athletes who engage in activities involving repetitive sprinting, kicking, or twisting movements. Over the last decade this condition has become more commonly described as several wellknown professional athletes have undergone surgical treatment of this condition. As a syndrome, ap is difficult to diagnose both with clinical examination and imaging. Athletic pubalgia and sports hernia rsna publications online.
Zoga, md assistant professor of radiology director of ambulatory imaging services and musculoskeletal. The term athletic pubalgia seems a much better fit than sports hernia since the former term captures the idea of multiple possible afflictions around the pubis. However, due to the number of potential differential diagnoses for athletes with chronic pain in the groin and lower abdominal region. Inflexible, tight, damaged and weakened hip flexor muscles and. Oct 03, 20 athletic pubalgia is a general term for many of the pubic bonebased muscle or tendon injuries. A sports hernia sh is the term used to describe a painful injury to the soft tissues of the groin. Athletic pubalgia or sports hernia is a syndrome of chronic lower abdomen and groin pain that may occur in both athletes and nonathletes. Importance groin pain in active individuals and athletes without clinical evidence of hernia or hip pathologic findings is challenging for health care clinicians and aggravating for those experiencing pain. Athletic pubalgia ap is a chronic debilitating syndrome that affects many athletes. Athletic pubalgia is most frequently diagnosed in highperformance male athletes. It occurs most often in athletes who participate in sports requiring quick changes in direction or fast twisting motions. Multiple pathologies often coexist, and many systems can refer pain to the groin.
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