Sports Hernia
Groin pain with no bulge
A sports hernia is an inguinal hernia that causes groin pain
with no apparent bulge. Pain typical of a sports hernia is a
sharp ache in the groin that is aggravated by exercise or other
activity. Many patients complain of pain shooting into the
scrotum or down to the testicle. Often the patient will remember
a specific injury event that started the pain. The pain is
severe and interferes with exercise, sports and sometimes sex.
Patients who see a doctor early on are usually told that they
have a muscle strain or a groin pull and are prescribed pain
medications and are told to take it easy for a few weeks. They
might feel a little better with rest but invariably the pain
starts back up as bad as ever when they try to resume more
strenuous activities.
On examination by a qualified physician no bulge is identified.
A bulge in the groin on examination is the one true sign of a
hernia and most doctors are reluctant to make the diagnosis of a
hernia if they cannot detect a bulge. In an effort to pin down
the diagnosis imaging studies such as ultrasound or MRI are
commonly ordered. These studies usually reveal nothing and are
of little to no value. We usually do not order these studies
unless we have a specific alternative diagnosis that we suspect.
When these studies are ordered for non-specific reasons and the
results are negative the situation may appear even more
confusing. But this is typical of sports hernias.
Diagnostic criterion
Our criterion for diagnosing a sports hernia is typical hernia pain in the typical location aggravated by activity and lasting more than 8 weeks unchanged. Other diagnoses reasonably suspected must of course be ruled out.
Other common conditions can cause groin pain. This is a partial list of those conditions:
- Muscle, tendon and ligament sprain
- Hip joint disease
- Appendicitis
- Diverticulitis
- kidney stones
- bladder diverticuli
- Lymph adenitis
- Infection of sebaceous cyst
- cellulitis
- pelvic fracture
- testicular torsion
- ovarian cyst
- uterine fibroids
- abdominal adhesions
- constipation
In the absence of a positive pathognomonic finding the diagnosis of a sports hernia is not 100% certain. This means that for typical patients we can not be absolutely sure of the diagnosis until we do the sports hernia surgery and see the pain go away after surgery. Adherence to proper diagnostic criterion allows us to identify most patients who will benefit from surgery and avoid unnecessary surgery.
Treatment of Sports Hernia
The only effective treatment of a sports hernia is inguinal herniorrhaphy. At surgery a small hernia is usually found. We prefer an open non-mesh anatomical repair. One of the issues with sports hernia patients that must be kept in mind is that they have very sensitive groins. We do not want these patients to have permanent groin pain as a result of the surgery. This is a situation where less is more. The less surgery that is done the better. The more complex the surgery is the greater the potential for scar tissue formation which can result in chronic pain. Also mesh is not a good idea for these types of hernias because mesh is well known to cause chronic pain.
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