Inguinal disruption (Gilmore’s groin)

Inguinal disruption/groin disruption are, apparently, two more names for the misnamed sports hernia, which I wrote about here.

Examination should include examination for a hernia, examination of the hip joint, and assessment for tenderness at the deep inguinal ring, superficial inguinal ring, and insertion of conjoint tendon. Since these areas are key to the diagnosis, a more specific description of how to find them clinically would have been really helpful for middle-aged GPs like me whose anatomy classes are a distant memory from more than half a lifetime ago, but, some internet searching later:

• Deep inguinal ring: just above the midpoint of the inguinal ligament. IOW, midway between the AS iliac spine and the pubic tubercle.
• Superficial inguinal ring: just superior to the pubic tubercle.
• Insertion of the conjoint tendon: the pubic crest, which is the bit between the pubic tubercle and the pubic symphysis.

Diagnosis of inguinal disruption (see previous linked article for further details on symptoms and management) is made by finding at least three out of the following five symptoms:

• Pinpoint tenderness over the pubic tubercle at the insertion of the conjoint tendon
• Palpable tenderness over the deep inguinal ring
• Pain or dilatation of the superficial inguinal ring without a hernia evident
• Pain at the origin of the adductor longus tendon
• Dull, diffuse groin pain (often radiating to perineum, inner thigh, or opposite groin)

This article gives 6 – 8 weeks as the timespan for trying conservative management (not 6 – 12 as the previous article did); this should include exercise physiotherapy (not a missed comma; exercise physio is A Thing and works better than passive physio for this problem) after the acute period, and reduction of activity/cessation of movements that cause the pain. If that works, aim for gradual return to sports. If not, refer to sports medicine or orthopaedics. Refer sooner if avoiding sports is going to have a considerable impact on the person’s life or if the diagnosis is uncertain.

(BMJ: Groin pain in athletes)