Original Article: Abdominal Wall Pain: Clinical Evaluation, Differential Diagnosis, and Treatment

Issue Date: October 1, 2018

See additional reader comments at: https://www.aafp.org/afp/2018/1001/p429.html

To the Editor: We agree with Drs. Shian and Larson that a complete understanding of the underlying anatomy is essential to narrow the differential diagnosis of abdominal wall pain. To this end, we suggest that clinicians no longer use the term sports hernia. As stated in the article, the term is a misnomer, and its use may lead to confusion among patients and physicians. Furthermore, studies have found that 11 to 33 different diagnostic terms have been used in the medical literature to describe this condition.^1,2

In response to the imprecise and widening vocabulary used to describe groin and lower abdominal pain in athletes, five categories for groin pain—defined by the affected anatomic region—were recommended at the 2015 Doha agreement meeting: adductor-related, iliopsoas-related, inguinal-related, pubic-related, and hip-related groin pain.² When a specific source of pain cannot be identified, the general term groin pain can be used. Removal of the terms sports and athlete was recommended because these injuries are not limited to athletes.

Appropriate use of the terms recommended by the Doha agreement may assist in better classification and diagnosis of abdominal wall injuries and in decreasing the heterogeneity among diagnostic terms. With better classification, we can avoid situations where patients hear the term sports hernia and believe they need surgery. This in turn could lead to more focused and specific treatment, and hopefully better understanding and outcomes for our patients.