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<v ->Let's take this 40 year old man,

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who's got pain with abdominal contractions,

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so-called Carnett sign,

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and difficulty with leg drive.

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He's 40, so the case is a little bit atypical

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for Sports Hernia or Sportsman's Hernia Syndrome,

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also known as Gilmore Groin, Hockey Goalie Syndrome,

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Adductor Syndrome, Slapshot Groin, and Rectus Strain.

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What's atypical is the patient

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is a little bit old, he's 40.

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Usually this occurs under age 35.

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They're athletic, they're men.

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It's very uncommon actually, before puberty,

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because of the elasticity and pliability of the tissues.

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And usually symptoms persist in Sports Hernia Syndrome

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for two to four weeks.

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They rest, they get better.

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And then as soon as they get back to play,

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they have symptoms again.

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27 to 30% of patients with Sports Hernia

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have multiple pathologies.

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So you can't just look at the rectus,

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the adductor, the linea alba.

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You've gotta look into the groin, into the obliques,

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and all the related areas that we'll talk about.

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40% of athletes will have some asymptomatic pathology

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on the contralateral side because they're compensating.

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So let's have a look at our case.

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I'm scrolling axially, and as we go up a little bit higher,

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I've got the rectus abdominis and I follow it down.

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I keep following the rectus using the T1 as a match.

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So I get my bearings anatomically.

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And as I start to come down,

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I see a little bit of asymmetric signal.

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Is that real?

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Well, yes it is.

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It's obliquely oriented.

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It has almost cleaved the undersurface

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of the rectus abdominis from its insertion and attachment

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on the pubic bone is the prepubic plate,

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and it continues on.

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It lateralizes and it keeps going.

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It even gets a little bit of the adductor muscle.

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There is the cleft sign, the separation of the adductors.

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So the adductors are involved down low.

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The prepubic plate is involved

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in the middle, at the level of the boat itself.

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And then as we go up, using our sail analogy,

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the mast is involved, namely the rectus abdominis.

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And we've even got a little involvement

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of the lateral structures.

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The sail, using the sailboat analogy, is involved too.

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Now, we also have some terrific anatomy on the axial T1.

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We can see the inguinal canal,

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which is something I routinely check in these individuals.

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Because sometimes irritation of the inguinal canal

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can present as Sports Hernia Syndrome.

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You can have irritation of the ilioinguinal ligament,

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of the ilioinguinal nerve, of the hood, the superior surface

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of the inguinal canal, the medial cruise,

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or the lateral crura of the inguinal canal.

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All of these things are potential contributions

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or compensatory injuries or strains that can happen

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with Sportsman's Hernia Syndrome on either side.

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The symptomatic side or the asymptomatic side.

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And then finally, on this axial oblique,

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and I'm gonna put up my sagittal just

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so you get a feel for how this is acquired,

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it is not a straight oblique, it's a steep axial oblique.

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So it's perpendicular to the pubis.

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A very important technique

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in properly evaluating Sports Hernia Syndrome.

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We're gonna go to the symptomatic side on the right.

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Keep your eye on our pubis, here.

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And then as we get over to the side on the pubis,

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there's your rectus cleft.

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There is your lower prepubic plate cleft.

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And then out to the side, you can see the separation

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on the axial oblique.

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The adductor separating from the pubic bone.

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This'll be as classic an example,

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as typical an example, of Sports Hernia

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or Sportsman's Hernia Syndrome,

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with the cleft side that you're going to see.