The Injury Clinic: The Hazleton Injury

USC wide receiver Vidal Hazelton underwent surgery for two muscle tears in his stomach that bothered him most of last season.

Hazelton played last season with what was thought to be a groin injury, but turned out to be multiple stomach tears. He is expected to be fully recovered for spring practice, which begins next month.

The surgery was performed in Philadelphia by Dr. William Meyers of Drexel University.

USC rarely sends an athlete to the Northeast for an operation, but Hazelton's family insisted the surgery be performed by an expert in abdominal surgery.

What is a sports hernia?

A sports hernia occurs when there is a weakening of the muscles or tendons of the lower abdominal wall. This part of the abdomen is the same region where an inguinal hernia occurs, called the inguinal canal. When an inguinal hernia occurs there is sufficient weakening of the abdominal wall to allow a pouch, the hernia, to be felt. In the case of a sports hernia, the problem is due to a weakening in the same abdominal wall muscles, but there is no palpable hernia.

What is the inguinal canal?

The inguinal canal is a region in the lower abdomen, just above the groin. The canal is formed by the insertions of abdominal muscles and tendons, as well as several ligaments. Within the inguinal canal travels the spermatic cord (in males) or the round ligament (in females). This area of the abdomen is prone to weakening of the abdominal wall, allowing an outpouching, or hernia, to form.

The Abdominal Muscles

The abdominal wall is made up of several muscles. These include:

• Rectus Abdominis: the muscle over the front of the belly-this muscle give people a "six-pack" appearance when the rectus is well developed.
• Internal and External Oblique: the obliqes wrap around the sides of the body.

Abdominal muscle strains are graded according to the severity of the injury:

• Grade I (Mild): Mild discomfort, often no disability. Usually does not limit activity.
• Grade II (Moderate): Moderate discomfort, can limit ability to perform activities such as crunches or twisting movements.
• Grade III (Severe): Severe injury that can cause pain with normal activities. Often patients complain of muscle spasm and bruising.

Abdominal muscle strains are graded according to the severity of the injury:

• Grade I (Mild): Mild discomfort, often no disability. Usually does not limit activity.
• Grade II (Moderate): Moderate discomfort, can limit ability to perform activities such as crunches or twisting movements.
• Grade III (Severe): Severe injury that can cause pain with normal activities. Often patients complain of muscle spasm and bruising.

The problem with the abdominal wall in people with a sports hernia is not a muscle strength issue. Rather, the abdominal wall in a particular region is too thin, allowing the hernia to form. The sports hernia does not occur in the area of the large, thick part of the muscle.

Symptoms

A sports hernia typically begins with a slow onset of aching pain in the lower abdominal region. Symptoms may include:

• Pain in the lower abdomen
  
• Pain in the groin
  
• Pain in the testicle (in males)

Typically the symptoms are exacerbated with activities such as running, cutting, and bending forward. Patients may also have increased symptoms when coughing or sneezing. Sports hernias are most common in athletes that have to maintain a bent forward position, such as hockey players. However, sports hernias are also found in many other types of athletes such as football and soccer players. Treatment

There are no treatments that have been shown to be effective for sports hernia other than surgery. That said, the initial treatment of a sports hernia is always conservative in hopes that the symptoms will resolve. Resting from activity, anti-inflammatory medications, ice treatments, and physical therapy can all be tried in an effort to alleviate the patient's symptoms.

If these measures do not relieve the symptoms of a sports hernia, surgery may be recommended to repair the weakened area of the abdominal wall. In number of studies have shown between 65% and 90% of athletes are able to return to their activity after surgery for a sports hernia. Rehabilitation from surgery for a sports hernia usually takes about eight weeks.

Laproscopic Hernia repair

A number of factors have led to the recent development of a new method of repair called laparoscopic hernia repair. This technique is really an extension of a traditional mesh repair method that was used in patients who had already experienced several hernia recurrences at the same site.

Previously, this mesh repair approach had required a separate incision somewhat removed from the target area. However, with the progressive development of the instruments and techniques for laparoscopic surgery, the same procedure can now be done with several relatively small incisions.

This allows the surgeon to enter the space behind the hernia defect and place the mesh with minimal injury to the surface of the abdomen. The advantages of this method include coverage of all the potential sites of groin hernia, which reduces the risks of recurrence while also decreasing the amount of post-surgical pain.