The term “sports hernia” was first coined in the 1980’s to refer to inguinal pain in athletes in whom physical exam did not reveal a hernia. It was thought that there was an ‘incipient hernia’ caused by a weakened posterior wall of the inguinal canal, but the exact location of this weakness was hotly disputed. Herniorrhaphy was used to treat these athletes, with mixed results.

Recent research has shown that the so-called “sports hernia” actually represents a group of disorders that occur at the symphysis pubis. Most commonly this involves a tear of the common aponeurosis of the rectus abdominus and adductor longus tendons as they insert along the anterior inferior symphysis.

When the ‘incipient hernia’ theory was still in vogue, imaging was thought to have no role in assessing sports hernias. However, MRI beautifully demonstrates the complex anatomy of this region and is well suited to make this diagnosis. MRI also helps to distinguish the aponeurosis tear from other entities that have a similar clinical presentation but different imaging appearance, such as adductor tendinopathy, osteitis pubis, hockey goalie-baseball pitcher syndrome (myofascial insertion of the adductor longus muscle), pubic ramus stress fracture and apophysitis.

If you have a patient with persistent athletic pubalgia, consider a tailored MRI to further investigate the complex anatomy of this area.

A great article for more in-depth review of this topic is “Athletic Pubalgia and ‘Sports Hernia’: Optimal MR Imaging Techniques and Findings” in RadioGraphics, Sept-Oct 2008, Volume 28, No. 5, pp. 1415-1438.

If you have any questions, please do not hesitate to contact us at:
New Castle County: 302-999-XRAY (9729)
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