Evaluation and treatment of groin pain syndromes in athletes

Justin W. Arner, Ryan Li, Ashley Disantis, Brian S. Zuckerbraun, Craig S. Mauro

Abstract

Groin pain syndromes, commonly referred to as sports hernias, are pathologic conditions which are not commonly well understood by those treating athletes despite making up approximately 6% of athletic injuries. The purpose of this article is to provide a comprehensive understanding and consistent nomenclature for appropriate identification and treatment of this relatively common condition. A computerized database search was conducted up to June 2019 and pertinent articles were cited using the terms sports hernia, athletic pubalgia, and groin pain. The quality and validity of the evidence was assessed based on journal prestige and impact factor as well as consistency with the other reviewed literature. The reviewed literature was inconsistent in terms of terminology. Few comprehensive reviews exist combining intra- and extra-articular causes of groin pain syndromes in athletes. Further, little orthopedic literature exists regarding pathologic inguinal and abdominal wall conditions. Groin pain syndromes refers to inguinal pain where the pathology is not caused by disturbances in the intra-articular hip joint, however, concomitant pathology in both locations are common. It is thought to be associated with a number of factors, including imbalances in abdominal and hip adductor strength, deficits in hip range of motion, poor tissue extensibility, and high intensity or high repetition hip adductor muscle shearing. The history and physical exam remain central to the appropriate diagnosis. Diagnostic imaging modalities such as MRI, CT, and diagnostic ultrasound are recommended due to difficulty of diagnosis based on physical exam alone. Non-operative treatment should first be attempted with surgical intervention yielding good outcomes in those that require it.