"Sportsman's hernia". Part one: Pathophysiology, nomenclature and treatment.

According to classic definition, hernia is a “displacement of parietal peritoneum and abdominal organs though a defect in the abdominal wall (natural or resulting from congenital defects) or a defect resulting from a disease condition or injury of abdominal wall (postoperative scars)” (1) This definition assumes existence of hernial orifice, hernial sac and its contents. Has this definition stood the test of time? Can it define complaints that result in surgical procedure that is performed in the presence of “classic” inguinal hernias? More and more often we must face patients presenting not with a hernia, but with pain that appeared suddenly or after an unspecific injury of the groin region. Half percent to 6.2% of professional athletes suffer from groin pain. This condition most often affects professional hockey and football players (2, 3, 4). Annually 10 to 18% complain of pain in the groin region, also referred to as “sportsman’s hernia” (5, 6). “Sportsman’s hernias” are among the least studied, least understood and worst defined human complaints. The term sportsman’s hernia includes a variety of diagnoses and wide range of pathological factors that must be either ruled out or confirmed before the final diagnosis is made (7). Various muscle, tendon and skeletal diseases of the groin region have a direct or indirect effect on walls of inguinal canal and on inguinal rings. Etiology of chronic pain in the groin region can be classified into four categories: 1) adductor enthesopathy Table 1. Determination of pain complaints in the groin region