Current understanding of core muscle injuries (Athletic Pubalgia, Sports Hernia)

Introduction: Groin injuries commonly encountered by physicians and surgeons who treat athletes of all ages and at all levels of competition may be quality-of-life changing or even career ending. The purpose of this chapter is to serve as a cornerstone foundation and also enhance the clarity of the current understanding of career-threatening soft tissue injuries of the pelvis. The misleading term sports hernia may mask an underlying diagnosis, consequently leading physicians and surgeons into incorrect management plans. Pathophysiology: In athletes, tremendous torque occurs at the level of the pelvis, and in particular the anterior pelvis, and the pubic bone functioning as a fulcrum for surrounding forces. Contraction of both large and small muscles here can create tremendous force, but, when one of these muscles weakens, it results in an inequality of forces on the pelvis, which can lead to pain, or athletic pubalgia. Results: Over the past two and a half decades, we have seen tremendous progress in not only identification of the different types of injuries and the treatments but also in the specific and overall success rates. One must not neglect the factors that may tilt the balance in judging success rates. Such factors include type and severity of injury, classification of the injuries according to specific anatomy involved, short- versus long-term success rates, defining the intervals of follow-up, competitive versus noncompetitive status, workmen's compensation claims, concomitant hip injuries, contract negotiations, methods of assessment, and carefully defining the injury(ies). Conclusion: Accurate diagnosis of the athlete with pelvic pain remains challenging. Appreciation of the complex anatomy is key, and then the various pathophysiologies and diagnostic and imaging techniques become almost intuitive. Successful outcomes result from precise diagnosis and therapy tailored to the individual patient and pathology.

Duke Scholars

Author William Clark Meyers Surgery