Athletic pubalgia

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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 sportsmen^[1]. Jerry Gilmore recognized the syndrome in 1980 and developed a surgical repair technique. It is a syndrome characterized by chronic groin pain in athletes and a dilated superficial ring of the inguinal canal. Soccer players are affected most frequently, and both recreational and professional athletes may be affected. A hernia cannot be found on physical examination or medical imaging, and is not present during surgery; thus the term hernia is a misnomer^[2].

The exact lesion may differ, but common pathologic findings at operation are ^[3] :

• torn external oblique aponeurosis
• tear in the conjoint tendon
• conjoint tendon torn from pubic tubercle
• dehiscence between conjoined tendon and inguinal ligament
• tear in the fascia transversalis ^[2]
• abnormal insertion of the rectus abdominis muscle
• tear of the abdominal internal oblique muscle from the pubic tubercle
• entrapment of the ilioinguinal nerve or genitofemoral nerve^[4]

Several of these lesions may occur simultaneously. Also, many athletes have concomitant weakness or tearing of the adductor muscles of the hip.^[3]

The exact incidence of this entity is unknown: some believe it is the most common cause of chronic groin pain in athletes, while others argue that it is only rare.^[5][6] Conservative therapies (gentle stretching and a short period of rest^[7]) may temporarily alleviate the pain, but definitive treatment exists of surgerical repair and rehabilitation^[3][5]

[edit] Notable cases

Well-known sufferers include:

• Patriots quarterback Tom Brady^[8]
• England cricketer Ashley Giles^[9]
• Philadelphia Eagles quarterback Donovan McNabb,^[10] (which is speculated to be part of the Madden curse).
• Los Angeles Galaxy soccer players Joseph Ngwenya and Benjamin Benditson^[11]

[edit] Notes

1. ^ Ahumada LA, Ashruf S, Espinosa-de-los-Monteros A, Long JN, de la Torre JI, Garth WP, Vasconez LO. "Athletic pubalgia: definition and surgical treatment". Ann Plast Surg 2005;55(4):393-6. PMID 16186706
2. ^ ^{a b} Joesting DR. "Diagnosis and treatment of sportsman's hernia". Curr Sports Med Rep 2002;1(2):121-4. PMID 12831721
3. ^ ^{a b c} "The Gilmore Groin & Hernia Clinic". Retrieved November 24, 2006.
4. ^ eMedicine sports/162
5. ^ ^{a b}
6. ^ Fredberg U, Kissmeyer-Nielsen P. "The sportsman's hernia--fact or fiction?" Scand J Med Sci Sports 1996;6(4):201-4. PMID 8896091
7. ^ GPnotebook 53477314
8. ^ "Brady's groin may be hurt". The Boston Globe, January 31, 2006. Retrieved December 3, 2006.
9. ^ "Angus Fraser: England play with fire over fitness for Ashes tour". The Independent, 13 September 2006. Retrieved December 3, 2006.
10. ^ J Cluett. "Donovan McNabb - Sports Hernia". Retrieved December 3, 2006.
11. ^ "Los Angeles Galaxy mini bios". November 10, 2005. Retrieved December 3, 2006.