The syndrome of Gilmore’s Groin goes under many names, including sportsman’s groin, sportsman’s hernia, groin disruption, inguinal disruption and inguinal related groin pain amongst many others! It is (nearly always) a sports related injury with a well-recognised set of symptoms and signs. The Gilmore Groin and Hernia Clinic, at 108 Harley Street, has been dealing with the condition for 35 years and there are two expert groin surgeons you can see, Mr Simon Marsh and Mr Emin Carapeti.
The first thing that will happen is that the doctor will “take your history”. This is simply asking you questions about what happened and what symptoms you get. In a third of people there is a specific injury that brings on the pain. This might have involved over stretching, excessive kicking or miskicking or perhaps the leg being forced away from the body or turned outwards forcibly. In most people it seems to be more of an “overuse” condition and the symptoms come on gradually. During sport pain in the groin increases with accelerating, sprinting, twisting and turning, lunging, dead ball kicking or long ball kicking. Typically the groin is stiff and sore for several days after exercise and there may be pain with sit-ups, rising from a low position (for example getting out of bed or in and out of a car), coughing, sneezing and any sudden movement. Usually there is nothing to see in the painful groin and in particular there is no lump. Very rarely if there has been a sudden, severe, tear there may be a lot of bruising. You will also asked about your general health and any operations or illnesses you may have had as well as about any tablets you take or allergies to nay medicines.
The next stage is the examination of the groin. Initially this is done standing up, to look at the site of the pain, and then lying down. The movement of your hips will be checked as well as if there are any particular movements that cause pain. When the groin itself is examined the key is the feel the “superficial inguinal ring”. In men this can be felt by (gently!) pushing up inside the top of the scrotum towards the groin. When the groin is torn this ring (which normally contains the cord bringing all the tubes and blood vessels to the testicle) gets pulled apart (dilated) and it is possible to feel the back of the groin (called the inguinal canal) through it. When the groin is torn this will be painful (compared with the uninjured side) and coughing will make the damaged groin muscles bulge forward. The findings are usually written as “when examined via the scrotum, the superficial inguinal ring is dilated and tender and there is a cough impulse indicating a groin disruption”. In women, for obvious reasons, the examination of this area is less helpful.
The next stage is to arrange any investigations to help confirm the diagnosis. The best single investigation now is a high resolution (3T) MRI scan. Not only is the high resolution important but it is also vital that the “correct protocols” are carried out. This means that the scans are done of the correct areas with the right resolution to see all the muscles and the hip joints. In addition the scans must be looked at (“reported”) by a specialist musculoskeletal radiologist who is used to working in a specialist groin team. Scans that do not meet these requirements may be inadequate and a further scan may need to be done. Occasionally an ultrasound scan may also be helpful as may x-rays of the hips and pelvis, or a test called a bone scan, but it is the MRI that is most important.
Whilst the combination of the history, examination and the MRI scan can make the correct diagnosis most of the time, the trouble is there are lots of other conditions that can cause similar symptoms and signs and it can sometimes be difficult to work out exactly what is causing the pain. Other conditions that can cause similar, or sometimes identical, pains include fractures, inflammation of the pubic tubercle (“osteitis pubis”), arthritis, bursitis, muscular tears in the adductor or thigh muscles and the syndrome of femoro-acetabular impingement. In this condition the “ball” of the hip joint on the top of the thigh bone, is the wrong shape and this can cause tears around the joint itself as well as inflammation. This can sometimes cause exactly the same pains as a groin tear. Whilst the abnormal shape of the hips is easily seen on the MRI scan, in many people this does not seem to cause any problems and it needs no treatment.
If, following discussion of your results, you wish to have your groin surgically repaired you will be given written information about the condition of Gilmore’s Groin, the operation and how it is done, how to look after your wound after the operation when you are at home and some rehabilitation exercises to start a few days after the operation. In addition you will be given the clinic telephone contact numbers if you need any further advice. Everyone is seen after 4 weeks to check that everything has healed up and that the rehabilitation is progressing as it should. Most people are discharged at this stage, but some may need a further check in a few more weeks.