II. Pathophysiology

  1. More diverse posterior wall defects than Sports Hernia
  2. Posterior abdominal wall abnormality or tear
    1. External oblique aponeurosis tear
    2. Conjoined tendon tear
    3. Dehiscence of conjoined and inguinal ligament
    4. Rectus abdominis Muscle tears

III. Symptoms

  1. Exertion Groin Pain
  2. Provocative
    1. Valsalva Maneuver provokes pain in only 10% of cases
    2. Pain on resisted adduction of hip (65%)
    3. Half sit-ups
    4. 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. Sports Hernia
    1. Lateral and superior to Groin Disruption

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

VIII. References

  1. Schleihauf (2019) Crit Dec Emerg Med 33(5): 19-28
  2. Morelli (2001) Am Fam Physician 64(8):1405-14 [PubMed]

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