II. Pathophysiology

  1. Weakening of posterior inguinal wall
  2. Results in occult, non-palpable Hernia

III. Symptoms

  1. Chronic deep Groin Pain in athlete
  2. Insidious onset with gradual worsening
  3. Radiation
    1. Inguinal ligament
    2. Perineum
    3. Rectus muscles
    4. Testicular Pain (30%)
  4. Provocative
    1. Increased intra-abdominal pressure

IV. Signs

  1. Inguinal Hernia not detectable (affects posterior wall)
  2. Difficult to diagnose except during surgery

V. Differential diagnosis

  1. Distal rectus strain or avulsion
  2. Groin Disruption (medial and inferior to Sports Hernia)

VI. Radiology

  1. Imaging rules out other diagnoses

VII. Management

  1. Conservative therapy trial for 2-3 weeks
  2. Surgical exploration if conservative therapy fails
    1. Successful return to sport in 90% of cases

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