Gary Stone on Sportsman's Hernia

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Gary Stone explains sports injury, treatment, and results

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Gary Stone on Sportsman's Hernia

  1. 1. Sportsman ’ s Hernia A treatable entity
  2. 2. What is a sportsman ’ s hernia? ? Probably: Conjoined tendon tear Transversalis tear
  3. 3. Previous descriptions Gilmore ’ s groin 1992: groin disruption Ext oblique Conjoined tendon Dehiscence inguinal ligament and conjoined tendon Clinical diagnosis based on symptoms and physical findings
  4. 4. Gilmore ’ s groin Chronic pain in inguinal region-22w Often also adductor origin pain Onset gradual; 28% specific injury Dilated superficial inguinal ring, cough impulse and tenderness (only 75% tender) (?where) Associated adductor injury “refractory”
  5. 5. Gilmore ’ s groin Transversalis fascia plicated Conjoined tendon repaired Nylon darn- tendon to ligament External oblique repaired
  6. 6. Other names Athletic hernia Sport ’ s hernia Pubalgia Soccer players ’ groin Hockey groin syndrome
  7. 7. Differential diagnosis Nerve entrapment Adductor strain Rectus abdominis strain Osteitis pubis Lumbosacral/hip/sacroiliac aetiologies
  8. 8. Gary Stone criteria Chronic inguinal pain (6 months) Other pathology excluded Refractory to other treatment Tender specifically over conjoined tendon Severe disruption to career/lifestyle
  9. 12. Investigations X-ray U/S Bone scan MRI Herniogram
  10. 13. Laparoscopic repair sportsman ’ s hernia 36 consecutive cases 1992-2005 Laparoscopic inguinal hernioplasty – 2 transperitoneal – 34 extra-peritoneal
  11. 14. Patient data All men Median age 33 Referral sports medicine 29 GP 7
  12. 15. Presenting complaint Unilateral groin pain 24 Bilateral groin pain 4 Groin and other 4 Groin and spreading 2 Lower abdomen 2 usually vague pain, but not at rest Unilateral groin pain 24 Bilateral groin pain 4 Groin and other 4 Groin and spreading 2 Lower abdomen 2
  13. 16. Presenting complaint Sudden onset 22 Sudden and gradual deterioration 5 Gradual onset 9
  14. 17. Activities precluded Running 14 Coughing 10 Walking 5 Lifting 5 Sport 5 Turning over in bed 4
  15. 18. Examination findings Conjoined tenderness14 Bilateral conjoined tenderness 6  Conjoined and other 4  Hasselbach’s tenderness 2 Bilateral Hasselbach’s 2   Cough impulse 2  Internal ring tenderness 3 Conjoined tenderness 14     Bilateral conjoined tenderness 6     Conjoined and other 4     Hasselbach’s tenderness 2     Bilateral Hasselbach’s 2     Cough impulse 2     Internal ring tenderness 3
  16. 19. Examination findings Unilateral tenderness 27 Bilateral tenderness 9
  17. 20. Length of history Median 3.5 months Mean 7.6 months
  18. 21. Investigations X-ray 17 Bone scan 15 U/S 13 MRI 4 Nil 3
  19. 22. Prior treatment Prednisone 7 Physiotherapy 20 Steroid injection 5 Rest all
  20. 23. Length of history Time from injury to surgery median 8 months mean 10.1 months
  21. 24. Sports Soccer 10 Rugby 9 Running 5 Golf 2
  22. 25. Hospital stay Median 1 night
  23. 26. Follow up Median 42 months Mean 43.1 months Range 1-120 months
  24. 27. Operation findings NIL 13 Small lipoma 8 Bulge 6 Moderate/large lipoma 4 Indirect sac 2 Contralateral indirect hernia 2
  25. 28. Recovery Return to physical activity median 1 week Return to sport median 4 weeks
  26. 29. Patient satisfaction Excellent 22 Good 9 No better, relapse 4 Neutral 1    
  27. 30. Patient satisfaction Glad you had the operation? Yes 32 No 3 Neutral 1
  28. 31. Long term pain levels No Pain 22 A little pain 10 Still in pain 4
  29. 32. Subsequent treatment Further groin surgery 1   Hip surgery 1 One side relieved only 1 Pain returned after 4 years 1 Hamstring pain 1
  30. 33. Complications Hydrocele 2 Tack pain 2
  31. 34. Further treatment Nil 23 Physio 6 Hip surgery 1 Groin surgery 1 Scan 1 Steroid injection 1 Hydrocele repair 1 Further consultation 1
  32. 35. Treatment success Excellent/good 89% No better/relapse 11%    
  33. 36. Conclusions Successful, durable, efficient treatment for intractable chronic groin pain Last resort Careful informed consent Diagnose with sports medicine Beware associated pain, bilateral

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