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Updated: Jun 1 2021

Athletic Pubalgia & Adductor strain

Images hernia.jpg
  • summary
    • Athletic Pubalgia is a clinical entity characterized by anterior pelvic/groin pain, commonly referred to as "sports hernia," thought to occur as a result of an adductor muscle strain due to direct trauma or overuse microtrauma.
    • Diagnosis is made clinically by tenderness over the adductor longus and groin pain that worsens with sitting up or valsalva maneuvers.
    • Treatment is nonoperative with rest and physical therapy.
  • Epidemiology
    • Demographics
      • males > females
      • common in hockey players and soccer players
    • Anatomic location
      • muscles of abdominal wall or adductor longus
  • Etiology
    • Pathophysiology
      • mechanism of injury
        • may be caused by acute trauma or microtrauma caused by overuse
        • thought to be caused by abdominal hyperextension and thigh abduction
          • specific injury to the common aponeurosis between the rectus abdominis and adductor longus is thought to be source of pain
  • Presentation
    • Symptoms
      • lower abdominal pain and inguinal pain at extremes of exertion
    • Physical exam
      • inspection
        • tenderness to adductor longus
      • provocative tests
        • pain with valsalva and situps
  • Imaging
    • Obtain radiographs, MRI, and bone scan to rule out other cause of symptoms
  • Differential
    • Must be differentiated from subtle true inguinal hernia
  • Treatment
    • Nonoperative
      • rest and physical therapy for 6-8 weeks
        • indications
          • first line of treatment
    • Operative
      • pelvic floor repair (hernia operation) vs. adductor / rectus recession
        • indications
          • after extensive nonoperative treatment fails
      • decompression of the genital branch of the genitofemoral nerve
        • indications
          • after extensive nonoperative treatment fails
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