Many athletes with a sports hernia present with significant pain at the medial attachment of the inguinal ligament. The inguinal ligament attaches to the anterior superior iliac spine and then travels down to attach to the pubic bone at the pubic tubercle. Most of the abdominal wall musculature attaches to the inguinal ligament, thus inguinal ligament is subject to many of the same stresses that can cause injury to the oblique muscles and to the adductor tendons.
When examining a patient with a sports hernia it is very important to include careful evaluation of the medial attachment of the inguinal ligament. I check for pain with palpation and for thickening of the ligament. The diagnosis can be confirmed by infiltrating the medial attachment of the inguinal ligament with local anesthetic. If the athlete improves, that confirms the diagnosis.
The injury can also be seen on an MRI and ultrasound. Treatment of this injury needs to be part of the overall plan for the athlete. Non-operative treatment includes steroid injections and radiofrequency denervation. Surgical options are to detach the medial attachment of the inguinal ligament and then rolling it up onto and sewing it to the conjoined tendon. During a laparoscopic procedure, the inguinal ligament can also be released and reinforced with mesh. Surgical results are excellent and add very little time to the overall operation.
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