Gilmore's groin
Encyclopedia
Athletic pubalgia, also called the sportman's hernia or sports hernia, Gilmore's groin or groin disruption, is a medical condition of the groin
affecting athletes.
It is a syndrome characterized by chronic groin pain in athletes and a dilated superficial ring
of the inguinal canal
. Football
and ice hockey
players are affected most frequently, and both recreational and professional athletes may be affected.
Following sporting activity the person with athletic pubalgia will be stiff and sore. The day after a match, getting out of bed or a car will be difficult. Any exertion that increases intra-abdominal pressure, such as coughing, sneezing, or sporting activity can cause pain. In the early stages, the person may be able to continue playing their sport, but the problem usually gets progressively worse.
As pain in the groin and pelvis can be referred from a number of problems, including injuries to the lumbar spine, the hip joint, the sacro-iliac joint, the abdomen, and the genito-urinary system, diagnosis of athletic pubalgia requires skillful differentiation and pubic examination in certain cases where there is intense groin pain.
The diagnosis of Gilmore's groin is based on the patient's history, clinical signs, and, increasingly, an MRI exam. The most notable clinical sign is dilation of the superficial inguinal ring on the affected side, which can be palpated by the examining doctor when the scrotum is inverted with the little finger. Typically, there is specific pain on coughing and sneezing, as well as sitting up and squeezing the legs together.
The exact lesion may differ, but common pathologic
findings at operation are:
Several of these lesions may occur simultaneously. Also, many athletes have concomitant weakness or tearing of the adductor muscles or labral tears of the hip.
When the adductor muscles are tight post injury, that can be enough to trigger symptoms. The first conservative treatment option should be to restore normal motion after the adductor has begun to heal (usually 6-8 weeks post injury). Sleeping in a prone position with the hip on the affected side flexed and externally rotated can be a cure in some individuals.
The exact incidence
of these entities is unknown: some believe it is the most common cause of chronic groin pain in athletes, while others argue that it is only rare. Conservative therapies (gentle stretching
and a short period of rest) may temporarily alleviate the pain, but definitive treatment consists of surgical repair followed by a structured rehabilitation.
Groin
In human anatomy, the groin areas are the two creases at the junction of the torso with the legs, on either side of the pubic area. This is also known as the medial compartment of the thigh. A pulled groin muscle usually refers to a painful injury sustained by straining the hip adductor muscles...
affecting athletes.
It is a syndrome characterized by chronic groin pain in athletes and a dilated superficial ring
Superficial inguinal ring
The superficial inguinal ring is an anatomical structure in the anterior wall of the human abdomen. It is a triangular opening that forms the exit of the inguinal canal, which houses the ilioinguinal nerve, the genital branch of the genitofemoral nerve, and the spermatic cord or the round ligament...
of the inguinal canal
Inguinal canal
The inguinal canal is a passage in the anterior abdominal wall which in men conveys the spermatic cord and in women the round ligament. The inguinal canal is larger and more prominent in men.-Site:...
. Football
Football
Football may refer to one of a number of team sports which all involve, to varying degrees, kicking a ball with the foot to score a goal. The most popular of these sports worldwide is association football, more commonly known as just "football" or "soccer"...
and ice hockey
Ice hockey
Ice hockey, often referred to as hockey, is a team sport played on ice, in which skaters use wooden or composite sticks to shoot a hard rubber puck into their opponent's net. The game is played between two teams of six players each. Five members of each team skate up and down the ice trying to take...
players are affected most frequently, and both recreational and professional athletes may be affected.
Presentation
Symptoms include pain during sports movements, particularly hip extension, and twisting and turning. This pain usually radiates to the adductor muscle region and even the testicles, although it is often difficult for the patient to pin-point the exact location.Following sporting activity the person with athletic pubalgia will be stiff and sore. The day after a match, getting out of bed or a car will be difficult. Any exertion that increases intra-abdominal pressure, such as coughing, sneezing, or sporting activity can cause pain. In the early stages, the person may be able to continue playing their sport, but the problem usually gets progressively worse.
As pain in the groin and pelvis can be referred from a number of problems, including injuries to the lumbar spine, the hip joint, the sacro-iliac joint, the abdomen, and the genito-urinary system, diagnosis of athletic pubalgia requires skillful differentiation and pubic examination in certain cases where there is intense groin pain.
The diagnosis of Gilmore's groin is based on the patient's history, clinical signs, and, increasingly, an MRI exam. The most notable clinical sign is dilation of the superficial inguinal ring on the affected side, which can be palpated by the examining doctor when the scrotum is inverted with the little finger. Typically, there is specific pain on coughing and sneezing, as well as sitting up and squeezing the legs together.
The exact lesion may differ, but common pathologic
Pathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....
findings at operation are:
- torn external oblique aponeurosisAponeurosis of the Obliquus externus abdominisThe aponeurosis of the Obliquus externus abdominis is a thin but strong membranous structure, the fibers of which are directed downward and medially....
- tear in the conjoint tendonConjoint tendonThe conjoint tendon is a structure formed from the lower part transversus abdominis muscle as it inserts into the crest of the pubis and pectineal line immediately behind the superficial inguinal ring. It is usually conjoint with the tendon of the abdominal internal oblique muscle, but they may be...
- conjoint tendon torn from pubic tuberclePubic tubercleThe pubic tubercle is a prominent forward-projecting tubercle on the upper border of the medial portion of the superior ramus of the pubis...
- dehiscence between conjoined tendon and inguinal ligamentInguinal ligamentThe inguinal ligament is a band running from the pubic tubercle to the anterior superior iliac spine. Its anatomy is very important for operating on hernia patients.-Anatomy:...
- tear in the fascia transversalis
- abnormal insertion of the rectus abdominis muscleRectus abdominis muscleThe rectus abdominis muscle, also known as the "six pack", is a paired muscle running vertically on each side of the anterior wall of the human abdomen . There are two parallel muscles, separated by a midline band of connective tissue called the linea alba...
- tear of the abdominal internal oblique muscleAbdominal internal oblique muscleThe internal oblique muscle is the intermediate muscle of the abdomen, lying just underneath the external oblique and just above the transverse abdominal muscle.-Structure:...
from the pubic tubercle - entrapment of the ilioinguinal nerveIlioinguinal nerveThe ilioinguinal nerve is a branch of the first lumbar nerve . It separates from the first lumbar nerve along with the larger iliohypogastric nerve....
or genitofemoral nerveGenitofemoral nerveIn human anatomy, the genitofemoral nerve originates from the upper part of the lumbar plexus of spinal nerves. Its roots are L1 and L2 .The genitofemoral nerve is responsible for both the efferent and afferent limbs of the cremasteric reflex...
Several of these lesions may occur simultaneously. Also, many athletes have concomitant weakness or tearing of the adductor muscles or labral tears of the hip.
When the adductor muscles are tight post injury, that can be enough to trigger symptoms. The first conservative treatment option should be to restore normal motion after the adductor has begun to heal (usually 6-8 weeks post injury). Sleeping in a prone position with the hip on the affected side flexed and externally rotated can be a cure in some individuals.
The exact incidence
Incidence (epidemiology)
Incidence is a measure of the risk of developing some new condition within a specified period of time. Although sometimes loosely expressed simply as the number of new cases during some time period, it is better expressed as a proportion or a rate with a denominator.Incidence proportion is the...
of these entities is unknown: some believe it is the most common cause of chronic groin pain in athletes, while others argue that it is only rare. Conservative therapies (gentle stretching
Stretching
Stretching is a form of physical exercise in which a specific skeletal muscle is deliberately elongated, often by abduction from the torso, in order to improve the muscle's felt elasticity and reaffirm comfortable muscle tone. The result is a feeling of increased muscle control, flexibility and...
and a short period of rest) may temporarily alleviate the pain, but definitive treatment consists of surgical repair followed by a structured rehabilitation.