Abstract
Sports pubalgia is a painful soft tissue injury in the area of the groin and seen most commonly in sports that require intense twisting movements or sudden change in direction. It rarely results in a true hernia and typically is a strain or tear of muscle, tendon, or ligament in the lower abdomen or groin area. Patients typically present with acute groin pain that improves with rest but often recurs with return to play. An appropriate examination and tests can help with proper identification of the problem and exclude other conditions. Conservative treatment involves rest, medications, and rehabilitation. More definitive treatment consists of surgical repair of the tears followed by further rehabilitation.
Keywords
Gilmore’s hernia, Groin Pain, Hernia, Pubalgia Strain
| Synonyms | |
| |
| ICD-10 Codes | |
| M77.9 | Tendinitis NOS |
| S39.91 | Groin injury (abdomen) |
| Use 7th character for the episode of care | |
| R10.30 | Groin pain (lower abdomen) |
| S39.011 | Groin strain (abdominal muscle) |
| S39.011 | Ilioinguinal strain (abdominal muscle) |
| S39.011 | Inguinal muscle strain (abdominal muscle) |
| M85.38 | Osteitis, other sites |
Definition
Although there is no universally accepted definition of this condition, pubalgia is pain in the groin area that is due to musculoskeletal causes. Despite the prevalence of the condition, the literature is filled with varying etiologies, anatomy involved, and terminology. 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. The majority of the published studies include athletes involved in soccer, rugby, ice hockey, running, or football. The term sports hernia is often used; however, this is a misnomer and there is no true hernia. It is typically a multifactorial condition initially thought to be due to weakness of the posterior wall of the inguinal canal ( Fig. 59.1 ). These patients have no obvious hernias or symptoms, such as numbness, clicking, a lump, or dysuria, to suggest other etiologies. However, medical causes need to be considered and recognized before concluding that the pain is due to a musculoskeletal cause. The majority of the conditions resulting in chronic groin pain in athletes are musculoskeletal in origin. There is ample evidence that this condition is much more common in amateur and professional athletes compared to the general population.
Symptoms
The symptoms are often vague and diffuse and in the area of the lower abdomen, groin, or medial thigh. Often the pain is insidious in onset and is a chronic aching type of pain, but less commonly can present with acutely after trunk hyperextension or hip hyperabduction. Most athletes cannot remember how or when the pain started. The symptoms are worse during and after strenuous activity, such as sprinting, cutting, side-stepping, or kicking. Symptoms are exacerbated by an increase in abdominal pressure, such as coughing or sneezing. The pain may limit the ability to stand or sit. In men, the pain can radiate into the scrotum on the involved side and to the surrounding areas of the abdomen and lower back. Women may complain of a dull ache in the groin aggravated by physical exertion or intermittent neurological pain in the distribution of the ilioinguinal nerve.
Physical Examination
The findings on examination can be tenderness in the area of the pubic symphysis, or pain on contraction of the hip flexors, hip adductors, or abdominal muscles. Pain and tenderness at the external inguinal ring without a frank lump may be associated with pubalgia, but the presence of a lump would indicate an inguinal hernia. Tenderness and dilatation of the external inguinal ring can be found in up to 94% of patients with an athletic hernia. Reduced range of motion of the short adductors of the hip may indicate injury to these muscles. Decreased internal hip range of motion can be due to osteitis pubis, whereas generalized reduction in hip range of motion is suggestive of hip joint pathology. The muscles originating from the pubic area should be palpated to assess for possible strain (adductors, sartorius, rectus femoris, and rectus abdominis). A general examination of the region should be carried out to assess for other potential causes of the symptoms. This should include examination of the testis in men and the rectum in both sexes. A gynecological examination may be indicated in a female patient. A multidisciplinary approach to the evaluation should be considered in these patients, given the spectrum of potential diagnoses and various areas involved (abdomen, genitourinary system, musculoskeletal system).
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