Sports hernia
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Synopsis
A sports hernia (also known as athletic pubalgia) is a clinical diagnosis characterized by persistent groin pain resembling hernia pain but not attributed to abdominal or groin wall damage and, therefore, not considered a true hernia. The pathophysiology is believed to be an imbalance between the adductor muscles in the thigh and the abdominal muscles, leading to areas of weakness within the groin. It has gradual onset, is typically unilateral, and occurs more often in men than women. Sporting activities with repetitive high-speed twisting, bending, and torqueing that can cause damage to the abdominal, thigh, and groin muscles are often implicated, particularly when the patient lacks appropriate preconditioning. Sports hernias are most often reported in ice hockey players, football players, rugby players, soccer players, and sprinters, but they are not uncommon in recreational athletes of any sport.
Codes
ICD10CM:
S39.011A – Strain of muscle, fascia and tendon of abdomen, initial encounter
SNOMEDCT:
285348005 – Strain of abdominal muscle
S39.011A – Strain of muscle, fascia and tendon of abdomen, initial encounter
SNOMEDCT:
285348005 – Strain of abdominal muscle
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
The differential diagnosis can be split up into 3 categories:
Intra-articular pathologies
Intra-articular pathologies
- Femoroacetabular impingement syndrome (FAI) – Flexion, adduction, and internal rotation test may reproduce symptoms. Plain radiographs may show cam, pincer, or mixed morphology for diagnosis.
- Acetabular labral tear – MRI may show tear.
- Osteochondral lesion – Plain radiographs may show lesion.
- Femoral neck stress fracture – Plain radiographs may show fracture.
- Osteoarthritis – Often seen in older adults. Radiographs can show characteristic joint space changes.
- Transitory synovitis – Most often seen in patients aged 3-8 years. Often bilateral.
- Osteonecrosis of the femoral head – Seen on MRI without contrast.
- Osteochondritis dissecans – Plain radiographs often show characteristic bony lesion.
- Epiphysiolysis of the femoral head – Most often seen in adolescents. Plain radiographs may show characteristic findings.
- Septic arthritis – Joint aspiration will show evidence of infection.
- Tumor – Multiple imaging modalities may show tumor.
- Tendon strain or tendinopathy of hip flexor or adductor origin or rectus abdominis insertion – Physical examination may show focal pain.
- Adductor muscle strain – Physical examination may show focal pain. MRI may help to confirm.
- Osteitis pubis – Pubic symphysis tenderness may be present.
- Pubic ramus stress fracture – Focal tenderness. Plain radiographs and MRI show bony changes.
- Apophyseal avulsion fracture
- Snapping hip syndrome – Characteristic "snap" heard by patient or observer.
- Sacroiliac joint disorder – Tests of pelvic symmetry may be helpful.
- Lumbar radiculopathy – Characteristic clinical diagnosis.
- Nerve entrapment (ilioinguinal, obturator)
- Genitourinary
- Adnexal torsion – Ultrasound may be helpful.
- Ovarian cyst – Ultrasound may be helpful.
- Pelvic inflammatory disease – Patient is sexually active. Characteristic findings on pelvic examination.
- Urinary tract infection – Evidenced by history and urinalysis.
- Endometriosis – Seen on ultrasound.
- Nephrolithiasis – Evidenced by history and abdominal CT to visualize ureters / kidneys.
- Prostatitis (acute, chronic) – Digital rectal examination shows tender, edematous prostate.
- Epididymitis – Localized testicular pain with tenderness and swelling of epididymis.
- Orchitis – Localized testicular pain.
- Testicular torsion – Acute onset, negative cremasteric reflex, severe testicular pain.
- Testicular cancer – Evidenced by scrotal ultrasound.
- Intra-abdominal pathologies
- Inguinal hernia – Physical examination shows bulge in groin, confirmed by ultrasound.
- Appendicitis – McBurney's point tenderness, CT / ultrasound of abdomen, CBC.
- Diverticulitis / diverticulosis – Seen on CT with contrast.
- Lymphadenitis
- Inflammatory bowel disease (see Crohn disease, ulcerative colitis) – Evidenced by history, including gastrointestinal (GI) symptoms.
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Therapy
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References
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Last Reviewed:11/08/2020
Last Updated:04/26/2023
Last Updated:04/26/2023