II. Pathophysiology
- More diverse posterior wall defects than Sports Hernia
- Posterior abdominal wall abnormality or tear
- External oblique aponeurosis tear
- Conjoined tendon tear
- Dehiscence of conjoined and inguinal ligament
- Rectus abdominis Muscle tears
III. Symptoms
- Exertion Groin Pain
- Provocative
- Valsalva Maneuver provokes pain in only 10% of cases
- Pain on resisted adduction of hip (65%)
- Half sit-ups
- Increased intra-abdominal pressure
IV. Signs
- Inguinal Hernia not detectable (affects posterior wall)
- Difficult to diagnose except during surgery
V. Differential Diagnosis
-
Sports Hernia
- Lateral and superior to Groin Disruption
VI. Radiology
- Imaging rules out other diagnoses
VII. Management
- Conservative therapy trial for 2-3 weeks
- Surgical exploration if conservative therapy fails
- Successful return to sport in 90% of cases
VIII. References
- Schleihauf (2019) Crit Dec Emerg Med 33(5): 19-28
- Morelli (2001) Am Fam Physician 64(8):1405-14 [PubMed]