Ann Rehabil Med.  2015 Dec;39(6):1038-1041. 10.5535/arm.2015.39.6.1038.

Diagnosis of Groin Pain Associated With Sports Hernia Using Dynamic Ultrasound and Physical Examination: A Case Report

• Yang DC
• Nam KY
• Kwon BS
• Park JW
• Ryu KH
• Lee HJ
• Sim GJ

• KMID: 2165633
• DOI: http://doi.org/10.5535/arm.2015.39.6.1038

Abstract

Groin pain in athletes is a complex diagnostic and therapeutic challenge. Sports hernia is one of the common causes of groin pain. We report a case of sports hernia, initially presented as groin pain and aggravated by sports activity. A 19-year-old soccer player visited the outpatient department of general surgery and was referred to the rehabilitation center due to no abnormalities detected in the abdomen and pelvis by computed tomography. An incipient direct bulge of the posterior inguinal wall was detected with dynamic ultrasound when abdominal tension was induced by raising both legs during a full inhalation. Surgery was performed and preoperatively both groins showed the presence of inguinal hernia. Diagnosing sports hernia is very challenging. Through careful history documentation and physical examination followed by dynamic ultrasonography, we identified his posterior inguinal wall deficiency for early management.

Keyword

Sports injury; Hernia; Ultrasonography

MeSH Terms

Abdomen
Athletes
Athletic Injuries
Diagnosis*
Groin*
Hernia*
Hernia, Inguinal
Humans
Inhalation
Leg
Outpatients
Pelvis
Physical Examination*
Rehabilitation Centers
Soccer
Sports*
Ultrasonography*
Young Adult

Figure

• 

  Fig. 1 Axial view of the post-contrast abdomen and pelvis computed tomography at symphysis pubis level demonstrating no evidence of hernia.

• 

  Fig. 2 Diagram of the area where the patient felt pain.

• 

  Fig. 3 Short axis view of both sides of the posterior inguinal wall (A, left side; B, right side) with patient resting (left) and straining (right). When patient straining, incipient direct bulge of the posterior inguinal wall is seen, more prominent on left side. The superimposed red line indicates the posterior inguinal wall. It is initially concave when patient is at rest, but displaced anteriorly as a convex bulge (demonstrated with yellow arrow) on straining. Rectus abdominis (R) and lateral abdominal muscles (M) are indicated.

• 

  Fig. 4 (A) Axial and (B) obliquecoronal fat-saturated T2 images of the pelvic bone. Magnetic resonance imaging showing bilateral symmetric bone marrow edema (yellow arrow) and enhancement in both symphysis pubis (SP), more prominent in anteroinferior aspect. Note no abnormal findings in muscle and aponeurosis of both rectus abdominis (R) and adductor longus (A) around pubic bone (P). Spermatic cord (S) is also normal in place.

Reference

1. Johnson R. Osteitis pubis. Curr Sports Med Rep. 2003; 2:98–102. PMID: 12831666.

2. Brown A, Abrahams S, Remedios D, Chadwick SJ. Sports hernia: a clinical update. Br J Gen Pract. 2013; 63:e235–e237. PMID: 23561792.

3. Muschaweck U, Berger LM. Sportsmen's groin-diagnostic approach and treatment with the minimal repair technique: a single-center uncontrolled clinical review. Sports Health. 2010; 2:216–221. PMID: 23015941.

4. 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; 32:134–139. PMID: 9631220.

5. Jain M, Tantia O, Sasmal P, Khanna S, Sen B. Chronic groin pain in athletes: sportsman's hernia with bilateral femoral hernia. Indian J Surg. 2010; 72:343–346. PMID: 21938201.

6. Hackney RG. The sports hernia: a cause of chronic groin pain. Br J Sports Med. 1993; 27:58–62. PMID: 8457816.

7. Woodward JS, Parker A, Macdonald RM. Non-surgical treatment of a professional hockey player with the signs and symptoms of sports hernia: a case report. Int J Sports Phys Ther. 2012; 7:85–100. PMID: 22319682.

8. Verrall GM, Slavotinek JP, Fon GT. Incidence of pubic bone marrow oedema in Australian rules football players: relation to groin pain. Br J Sports Med. 2001; 35:28–33. PMID: 11157458.