Sports Hernia and the Inguinal Ligament

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.

Sources:

http://www.ncbi.nlm.nih.gov/pubmed/7827891

Br J Surg. 1994 Nov;81(11):1632-4.

Chronic obscure groin pain is commonly caused by enthesopathy: ‘tennis elbow’ of the groin.

Ashby EC1.

 

http://www.ncbi.nlm.nih.gov/pubmed/18716535

Laparoscopic inguinal ligament tenotomy and mesh reinforcement of the anterior abdominal wall: a new approach for the management of chronic groin pain.

Lloyd DM, Sutton CD, Altafa A, Fareed K, Bloxham L, Spencer L, Garcea G.

Surg Laparosc Endosc Percutan Tech. 2008 Aug;18(4):363-8.

 

http://www.ncbi.nlm.nih.gov/pubmed/22952407

Br J Sports Med. 2013 Apr;47(6):380-6. doi: 10.1136/bjsports-2012-091129. Epub 2012 Sep 5.

Radiofrequency denervation of the inguinal ligament for the treatment of ‘Sportsman’s Hernia’: a pilot study.

Comin J1, Obaid H, Lammers G, Moore J, Wotherspoon M, Connell D.

William Brown, MD
Hernia Specialist

Dr. Brown has been repairing inguinal hernias for over 30 years, taking care of Athletes with Sports Hernia injuries since 1999.  Dr. Brown has been taking care of patients with complications from mesh for so long that his hair is gray. Luckily he still has some hair.

His patients include players from the San Jose Sharks and the San Jose Earthquakes as well as athletes from the NFL, AFL, NBA, and the local college teams. As well as Athletes from 15 foreign countries.

Location:
Fremont Office
William H. Brown, M.D.
39470 Paseo Padre Pkwy
Fremont, CA 94538
(510) 793-2404
Fax: (510) 793-1320

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