Groin strain

• often involves tears to the adductor muscles - commonly high up to their attachment to the pubic bone (1)
  
  
• the medial border of the superficial ring is formed by the common attachment of traversalis abdominis and the external oblique
  • the exact location of this weakness or tear is disputed; Gilmore favored the external oblique muscle aponeurosis and conjoined tendon (2), while others believed it was in the transversalis fascia (3)
    
    
    • the operative findings in a case of Gilmore's groin are varied and include:
      • torn external oblique aponeurosis
      • tear in the conjoint tendon
      • conjoint tendon torn from pubic tubercle
      • dehiscence between conjoined tendon and inguinal ligament
      • tear in the fascia transversalis
      • abnormal insertion of the rectus abdominis
      • muscle tear of the abdominal internal oblique muscle from the pubic tubercle
      • entrapment of the ilioinguinal nerve or genitofemoral nerve
        
        
  • when injured this structure causes pain in the groin that is sometimes referred to the abdomen, testicle and sometimes the other side. There is rarely any hernia. Characteristically the patient (often a footballer) complains of a grumbling groin pain that subsides with rest but recurs with activity. There is tenderness over the pubic bone and also over the inguinal ring
    
    
• diagnosis
  • via history and examination, MRI findings (4)
    
    
• treatment
  • conservative treatment
    • some resolution may be achieved via gentle stretching during healing with a short period of rest (1)
    • other conservative therapies include
      • physiotherapy, NSAIDs
  • surgical treatment
    • may be required
    • surgical repair and structured rehabilitation

Always consider other causes of groin pain.

Reference:

• 1) The Practitioner 1997;241: 440-4.
• 2) Gilmore J. Groin pain in the soccer athlete: fact, fiction, and treatment. Clin Sports Med 1998; 17: 787-793
• 3) Irshad K, Feldman LS, Lavoie C, Lacroix VJ, Mulder DS, Brown RA. Operative management of 'hockey groin syndrome': 12 years of experience in National Hockey League players. Surgery 2001; 30: 759-764.
• 4) Omar IM et al. Athletic pubalgia and 'sports hernia': optimal MR imaging technique and findings. Radiographics. 2008 Sep-Oct;28(5):1415-38.