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<v ->So this 23-year-old muscular professional tennis player

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had some repetitive symptoms, low-grade symptoms

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for a period of time and then during a match

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these symptoms exacerbated,

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slowed his tennis serve from 122 to about 100 miles per hour

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and he illustrates multiple tears.

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Some important anatomy that we'll review right now

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as it relates to the rectus abdominis.

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Here's your linea alba,

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which takes origin from the ribs and the xiphoid area.

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There's the umbilicus as we come down.

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He's got a linea alba middle tear, right in the center.

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He's got a central rectus bundle tear.

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He's got a lateral rectus bundle tear.

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He's got a linea semilunaris tear.

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In this particular patient,

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very well-developed lateral bundle

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of the rectus abdominis.

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Let's go up a little higher.

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And see here's this well-developed lateral bundle,

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which in most individuals

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is bigger than the medial bundle.

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On this axial water-weighted image,

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the tears are also obvious

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in the linea alba

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and in the medial bundle of the rectus abdominis.

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Now let's go up high for a minute

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and the back of the rectus abdominis looks fine.

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The linea semilunaris, not so much.

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It's abdominis.

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So the morphology at this level

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is associated with a split

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in the muscular aponeurotic layers

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so that the aponeurotic layers go in front and in the back,

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mostly the internal oblique

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separates to form the rectus aponeurosis.

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Yeah, there are some contributions in the back

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from the external oblique

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and also from the transverse abdominis,

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but these are rather delicate and scant

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compared to the internal oblique.

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Now, something interesting happens as we go down.

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When we get about halfway between the umbilicus

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and the pubis, right about here,

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now, let's go down to that level,

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the aponeurosis does this.

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Instead of splitting with a component in back

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and a component in front,

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all three components go in the front.

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Both the internal oblique,

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the transverse abdominis,

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and the external oblique.

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I didn't put them up in quite the right order,

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but I think you get the picture.

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So down low,

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it's rather important to make sure that there's no defects.

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That there's no edema,

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that there's no bulging

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of the rectus abdominis tissues posteriorly.

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So let's have a look.

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There is a little bit of bulging right here,

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so that's a little disturbing,

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but let's go further down and see what happens down low.

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Still a little bit of bulging,

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a little bit of high signal,

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still a little bit of high signal medially,

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and then that high signal goes away.

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So this is an important area to assess

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for focal areas of contour change

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which he does have, especially medially,

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focal areas of signal alteration

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which he does have medially because the aponeurotic layer

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is naturally deficient at this level.

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Another example of

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an acute on chronic sports hernia syndrome

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that involves the medial rectus,

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the lateral rectus,

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the linea semilunaris,

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the linea alba,

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and the posterior aponeurosis

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of a professional tennis player.

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Dr. P out.