New England Baptist Hospital, Boston, Massachusetts, USA.
New England Patriots, Foxboro, Massachusetts, USA.
Am J Sports Med. 2023 Mar;51(4):1087-1095. doi: 10.1177/03635465211063890. Epub 2022 Mar 2.
Pain in the groin region, where the abdominal musculature attaches to the pubis, is referred to as a "sports hernia,""athletic pubalgia," or "core muscle injury" and has become a topic of increased interest due to its challenging diagnosis. Identifying the cause of chronic groin pain is complicated because significant symptom overlap exists between disorders of the proximal thigh musculature, intra-articular hip pathology, and disorders of the abdominal musculature.
To present a comprehensive review of the pathoanatomic features, history and physical examination, and imaging modalities used to make the diagnosis of core muscle injury.
Narrative and literature review; Level of evidence, 4.
A comprehensive literature search was performed. Studies involving the diagnosis, treatment, and rehabilitation of athletes with core muscle injury were identified. In addition, the senior author's extensive experience with the care of professional, collegiate, and elite athletes was analyzed and compared with established treatment algorithms.
The differential diagnosis of groin pain in the athlete should include core muscle injury with or without adductor longus tendinopathy. Current scientific evidence is lacking in this field; however, consensus regarding terms and treatment algorithms was facilitated with the publication of the Doha agreement in 2015. Pain localized proximal to the inguinal ligament, especially in conjunction with tenderness at the rectus abdominis insertion, is highly suggestive of core muscle injury. Concomitant adductor longus tendinopathy is not uncommon in these athletes and should be investigated. The diagnosis of core muscle injury is a clinical one, although dynamic ultrasonography is becoming increasingly used as a diagnostic modality. Magnetic resonance imaging is not always diagnostic and may underestimate the true extent of a core muscle injury. Functional rehabilitation programs can often return athletes to the same level of play. If an athlete has been diagnosed with athletic pubalgia and has persistent symptoms despite 12 weeks of nonoperative treatment, a surgical repair using mesh and a relaxing myotomy of the conjoined tendon should be considered. The most common intraoperative finding is a deficient posterior wall of the inguinal canal with injury to the distal rectus abdominis. Return to play after surgery for an isolated sports hernia is typically allowed at 4 weeks; however, if an adductor release is performed as well, return to play occurs at 12 weeks.
Core muscle injury is a diagnosis that requires a high level of clinical suspicion and should be considered in any athlete with pain in the inguinal region. Concurrent adductor pathology is not uncommon.
腹股沟区域的疼痛，即腹直肌附着于耻骨处，被称为“运动疝”“运动性耻骨痛”或“核心肌肉损伤”，由于其具有挑战性的诊断，已成为一个日益受到关注的话题。由于近端大腿肌肉、髋关节腔内病理和腹部肌肉紊乱之间存在显著的症状重叠，因此确定慢性腹股沟疼痛的原因较为复杂。
对核心肌肉损伤的病理解剖特征、病史和体格检查以及影像学检查方法进行全面综述，以做出诊断。
叙述性和文献回顾；证据水平，4 级。
进行了全面的文献检索。确定了涉及运动员核心肌肉损伤的诊断、治疗和康复的研究。此外，还分析了资深作者在治疗专业、大学和精英运动员方面的丰富经验，并与既定的治疗方案进行了比较。
运动员腹股沟疼痛的鉴别诊断应包括伴有或不伴有内收长肌肌腱炎的核心肌肉损伤。该领域目前缺乏科学证据；然而，2015 年多哈协议的发表促进了术语和治疗方案的共识。腹股沟韧带近端的疼痛，特别是与腹直肌止点压痛相结合时，高度提示存在核心肌肉损伤。这些运动员中同时伴有内收长肌肌腱炎并不少见，应进行检查。核心肌肉损伤的诊断是临床诊断，尽管动态超声检查作为一种诊断手段越来越多地被使用。磁共振成像并不总是具有诊断性，并且可能低估了核心肌肉损伤的真实程度。功能康复方案通常可以使运动员恢复到相同的运动水平。如果运动员被诊断为运动性耻骨痛，并且在经过 12 周的非手术治疗后仍有持续症状，应考虑使用网片和联合腱松解术进行手术修复。最常见的术中发现是腹股沟管后壁缺陷和腹直肌远端损伤。对于单纯的运动疝，手术后 4 周即可恢复运动；然而，如果同时进行了内收肌松解术，12 周后即可恢复运动。
核心肌肉损伤是一种需要高度临床怀疑的诊断，应考虑任何腹股沟区域疼痛的运动员。并发的内收肌病变并不少见。
