The inguinal ligament is a band of fibrous tissue that starts at the anterior superior iliac spine and runs inferiorly and medially to attach to the pubic bone at the pubic tubercle. The rectus femoris muscle attaches to the inferior aspect and the external oblique muscle forms the superior aspect. It is called a ligament, but functionally it more like a tendon in that it is an extension of the external oblique’s muscle attachment to the bone. The medial attachment of the inguinal ligament is often damaged in athletes with sports hernias. It is very important that this injury is identified because if missed the athlete will have persistent pain after surgery.
The athlete will report pain at the pubic tubercle that is aggravated by acceleration. There is maybe some pain at rest. Direct pressure over the pubic tubercle will reproduce the pain. Often the medial inguinal ligaments and the pubic tubercle will be thicken on physical examination. MRI imaging will sometimes show signs of boney injury, but the false negative rate is high.
Diagnostic injections can be very helpful. Inject the medial aspect of the inguinal ligament and the surrounding periosteum with a local anesthetic and then ask the athlete to run around the building. If the athlete feels better, then that supports the fact that there is an injury to the inguinal ligament.
Initial treatment should be conservative. Rest, heat, analgesics. Steroid and PRP injections can be very helpful. Radio-frequency ablation has been used effectively. If the athlete requires surgery, then the inguinal ligament should be released and reattached to the conjoint tendon. This adds very little time to the operation and does not delay the recovery.
If you think you may be suffering from a sports hernia, please consider making an appointment with Dr. Brown to see if you’re right. Dr. Brown specializes in working with hernia patients, and is an expert at the process of diagnosis, treatment, and recovery.