Athlete's hernia
Treatment
The aim of the treatment of an athlete's hernia is to gently and successfully eliminate the defect in the groin and the cause of the pain so that sporting activities can be resumed promptly. With the diagnosis of athlete's hernia - after excluding other causes - the indication for surgery is made. In the case of an athlete's hernia with pain or even pulling, the isolated nerve branch entrapment usually needs to be treated surgically in addition to the abdominal wall defect. It is advisable to have the cause of the pain clarified before an operation - if necessary with a neurological examination. The nerve entrapment cannot usually be removed using a laparoscopic method, but can only be removed openly from the front via a small access to the anterior wall, which in athletes lies directly below the subcutaneous fatty tissue. Depending on the extent, changes in the muscles and connective tissue, and the load, the defect in the inguinal canal can only be treated with fascioplasty with suture (e.g. Shouldice), with mesh (e.g. Lichtenstein) or with combined fasciaplasty with suture and mesh (to avoid recurrences under the mesh). be supplied.
Symptoms
With athlete's hernia, patients report the following complaints in the groin, thigh and lower abdomen:
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Pull,
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feeling of pressure,
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changes in sensitivity,
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Pain in the groin radiating to the genital area and inner thigh
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Pain when sitting for long periods
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Pain when standing up after a long journey.
The symptoms occur constantly or recurrently and can be triggered by certain movements and stress.
The bulge typical of an inguinal hernia is often missing. The existing changes in Valsalva can be seen on ultrasound.
It is important to determine whether other causes of the symptoms can be identified. Pathological changes in the bones in the pelvis, hip and thigh (pubic osteitis, impingement, activated hip osteoarthritis) or inflammation of the tendon attachment (adductor tendonitis) can cause similar symptoms. The symptoms can be spread and have their origin in the lumbar spine (herniated disc, spondyloarthritis, narrowing of the foramen, pinched nerves). Pathological changes in the urinary organs (kidneys, bladder, ureters, ureters) can cause flank and groin pain. Intestinal changes (sigmoid diverticulitis, diverticulitis) lead to pain
in the lower abdomen. Similar to carpal tunnel syndrome of the hand, nerve constriction syndromes in the groin (compression neuropathy) can cause severe groin pain that radiates to the genital area and thigh. Vascular changes in the aorta, iliac and leg arteries are possible changes associated with groin pain. In chronic abdominal wall pain in the area of the rectus abdominis muscle, the nerve is pinched as it passes through the abdominal wall (Carnett test). In some cases, there may be multiple causes that can only be localized after surgical treatment of the athlete's hernia.
Causes
Overloading of the structures of the abdominal wall and the inguinal canal during sports in conjunction with weak connective tissue are the cause of athlete's hernia. This results in injuries to the posterior wall (fascia transversalis), the transversus abdominis muscle and the internal oblique muscle (conjoint tendon), which are noticeable on ultrasound due to increased forward movement during pressing (Valsalva). The cause of the pain is usually an isolated entrapment of a cutaneous nerve branch of the ilioinguinal nerve and/or the genitofemoral nerve in the anterior wall (external aponeurosis) of the groin. Intraoperatively, with appropriate experience and microscopic magnification, it can be recognized which nerve branch is pinched and thus changed.