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<v ->Doctor P. here talking about sports hernias.

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I like to think of sports hernias as kinda the classic type,

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which most sports medicine physicians understand

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and have read about and that really is the central

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soft tissue musculotendinous type,

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and then the atypical type which may be off to the side

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or involve some of the other structures

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that produce the same syndrome,

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lack of power, inability to twist, groin pain,

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dull ache in the groin, and so on.

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So my goal in this vignette is to talk about anatomy

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in the classic sports hernia syndrome.

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And we've got the rectus abdominis, not the whole thing

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but the lower portion of the rectus.

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We've got the central aponeurosis or linea alba.

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We've got the musculotendinous attachments of the rectus.

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Now the rectus is invested in an aponeurotic sheath

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that is mostly formed by the internal oblique muscle.

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Then as it comes down, so we've got one main component,

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the rectus and its tendon,

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then as we come down, we've got the pre-pubic plate.

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The pre-pubic plate is continuous

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with the adductor longus tendons,

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and also involved in sports hernia syndrome

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is the pectineus.

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So we consider the adductor longus pectineus complex

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as part of the sports hernia syndrome complex.

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Then a structure I don't have on here 'cause it's hidden,

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but I'm gonna draw it in,

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is the ligament that sits immediately

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underneath the symphysis pubis,

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pubis is behind here including the pubic periosteum

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which is part of this complex of anatomy

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and this is known as the arcuate ligament,

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so I'll put A-R-C for that.

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So we've got basically five components,

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rectus abdominis, remember it goes off the screen,

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adductor longus and pectineus,

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arcuate and pubic periosteum.

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Basic, basic, the key structures

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involved in sports hernia syndrome.

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Now look at where the lateral aspect

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of the rectus aponeurosis sits,

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right adjacent to the inguinal ligament.

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So if you have a little tear right here,

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so you got something like this

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that's the cause of your sports hernia syndrome,

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which by the way, is not uncommon,

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and this is known as the cleft sign,

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especially when it separates

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from the underlying pubic periosteum,

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look at how close it is to the inguinal ligament structures.

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And it produces referred pain going right down,

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in this case, the right side of the groin

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into the scrotal area.

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This is a very common cause and presentation

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of one of the typical types of sports hernia syndrome.

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I'm not gonna talk much about the fascial tissues.

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There's something called Camper's fascia

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around here and Scarpa's fascia.

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They're not as important in the actual syndrome

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that we're here to discuss.

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Let's move on.

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Doctor P. out.