II. Indications

  1. Male Genital Exam
  2. Inguinal Hernia evaluation (men and women)

III. Anatomy

  1. See also Hesselbach's Triangle
  2. Inguinal Canal components
    1. Internal Inguinal Ring
      1. Lateral to inferior epigastrics
      2. Landmark: Middle of inguinal ligament
    2. Canal
      1. Carries spermatic cord in men
      2. Carries round ligament in women
    3. External Inguinal Ring
      1. Located at pubic tubercle
      2. Occurs just above inguinal ligament
      3. Medial and inferior to Internal Inguinal Ring

IV. Exam: Technique for Inguinal Canal palpation in men

  1. Place fingertip at most dependent portion of Scrotum
  2. Invaginate scrotal wall to External Inguinal Ring
  3. Gently insert finger into canal along spermatic cord
    1. Move finger laterally and cephalad
    2. Patient coughs, strains or performs Valsalva Maneuver

V. Findings

  1. Inguinal Hernia
    1. Small Indirect Hernia may slightly tap end of finger
    2. Large Indirect Hernia may be palpable as mass
    3. Direct Inguinal Hernia may be felt on pad of finger
  2. Spermatic cord tenderness (Funiculitis)
  3. Spermatic cord Lipoma
  4. Hydrocele

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