DIAGNOSIS AND TREATMENT

mechanism. Gradually, microtrauma and fascial sprains can lead to tissue damage and inguinal canal disruption over a period of time. However in some cases a specific incidence can lead to macrotrau- ma; Jerry Gilmore (personal communication) has indicated that 28% of Gilmore's groins occur following a specific incident such as forced abduction, or a collision or mis-kicking.

Lau et al (article in press) (12) have found that a family history of hernia was the most important determinant factor for developing an inguinal hernia in adult males. A male with a family history of her- nia is 8 times more likely to develop an inguinal hernia. It may be that inherited similarities in posture, anatomy and tissue histology can predispose to the development of inguinal canal disruption.

DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS Patients presenting with inguinal hernia and Gilmore’s groin are typically male adults, who participate in kicking sports and/or multi directional sports that require rapid twisting and turning movements.

Both inguinal hernia and Gilmore’s groin are characterised by groin pain and weakness during sports movements, particularly twisting and turning. This pain usually radiates to the adductor muscle region and even the testicles, although typical of groin pain it is often difficult for the patient to pin-point.

Following sporting activity the person with inguinal canal disruption will typically experience groin stiffness and soreness. For instance, the day after a soccer match, getting out of bed or a car

DIAGNOSTIC PITFALLS!

Groin pain is notoriously difficult to diagnose. Investigations can occasionally produce red herrings. Pubic bone marrow oedema is often found on MRI in professional soccer players. Radiologists can report this as osteitis pubis (although true osteitis pubis is characterised more by changes at the pubic symphysis itself). Once the diagnosis of osteitis pubis has been made by the radiologist, there is a danger that conservative treatment can complacently focus on this. The symptoms improve with relative rest and repeat MRI 6-8 weeks later shows resolution of the earlier reported pubic bone marrow oedema. However this is often a false positive and the symptoms return on resumption of activity, because an inguinal canal disruption is present.

Conversely a dilated superficial inguinal ring can often blind the clinician to the presence of other pathologies. Pelvis and hip x-rays are essential to complete the clinical picture, before surgery to repair the inguinal canal, as bony pathologies and pelvic instability may be missed.

may be uncomfortable. Any exertion that increases intra-abdominal pressure, such as coughing, sneezing or sporting activity can cause pain. Resisted bilateral adduction is often weak and reproduces discomfort.

The onset of symptoms is gradual in most cases. In the early stages these symptoms may settle within a day or two and the person may

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