title: Athlete's hernia--a true, early direct inguinal hernia: diagnosis, pathophysiology, and surgical treatment.
abstract: Athlete's hernia (AH) is an activity limiting condition that presents as chronic inguinal pain in elite athletes. The diagnosis involves a thorough history and physical examination and can be aided by ultrasound interrogation of the groin. Operative treatment with a direct tissue repair  of the inguinal floor successfully alleviates symptoms and allows for full return to activity. A retrospective analysis of patients with the diagnosis of AH from January 1998 to May 2010 who underwent operative repair was reviewed. Patients were evaluated based on age, gender, sport, time  to presentation, subjective and objective physical findings, imaging findings, operative findings, length of follow-up, and return to activity. Ninety-six patients (6 females) with a median age of 22.6 years were evaluated. In the majority of these patients, operative exploration revealed  a wide external ring with separation of the fibers of the external oblique aponeurosis and an unprotected and bulging transverses abdominis aponeurosis, very akin to an early direct inguinal hernia. The mean initial follow-up time was 6 weeks at which point all but two of the patients were  able to resume their full level of activity without restrictions. The diagnosis of AH, although somewhat elusive, can be easily established with a high degree of suspicion after doing a thorough history and physical exam augmented with ultrasonography. AH is equivalent to an early direct inguinal  hernia found in young athletes and can be surgically corrected allowing return to full activity.
authors.affiliation: Office of Surgical Education, Division of General Surgery, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey 08903-0019, USA. chernyvs@umdnj.edu
authors.forename: Victoriya S
authors.initials: VS
authors.lastname: Chernyavsky
authors.forename: Tomer
authors.initials: T
authors.lastname: Davidov
authors.forename: Stanley Z
authors.initials: SZ
authors.lastname: Trooskin
authors.forename: Andrew
authors.initials: A
authors.lastname: Boyarsky
mesh_terms: D056352:Athletes; D002908:Chronic Disease; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D010808:Physical Examination / Q000379:methods*; D011182:Postoperative Care / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult