Sports hernia: diagnosis and therapeutic approach

Groin pain is a common entity in athletes involved in soccer, ice hockey, Australian Rules football, skiing, running, and hurdling. An increasingly recognized cause of groin pain in these athletes is a sports hernia, an occult hernia caused by weakness or tear of the posterior inguinal wall, without a clinically recognizable hernia, that leads to a condition of chronic groin pain. The patient typically presents with an insidious onset of activity-related, unilateral, deep groin pain that abates with rest. Although the physical examination reveals no detectable inguinal hernia, a tender, dilated superficial inguinal ring and tenderness of the posterior wall of the inguinal canal are found. The role of imaging studies in this condition is unclear; most imaging studies will be normal. Unlike most other types of groin pain, sports hernias rarely improve with nonsurgical measures; thus, open or laparoscopic herniorrhaphy should be considered.