Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

2. Groin Pain: A Neurologic
and Musculoskeletal Anatomic Review
Irmina Anna Gawlas and Warwick J. Peacock
Boundaries of the Inguinal Canal
As shown in Fig. 2.1 , the anterior wall of the inguinal canal is the
external oblique aponeurosis, reinforced laterally by the internal oblique
muscle [ 1 ]. The posterior wall is formed by the transversalis fascia laterally
and the conjoint tendon medially. The inguinal and lacunar ligaments
are the floor. The roof is formed by the fusion of the lowest fibers
of the transversus abdominus and internal oblique muscles, which
become the conjoint tendon, and insert onto the pubic crest.
Fascial Layers and the Inguinal Rings
In order to understand the course of the various structures that enter
and exit the inguinal canal, listed in Table 2.1 , the fascial layers and their
openings must first be conceptualized. In the male, the internal ring is
an opening in the transversalis fascia through which the vas deferens
enters on its course from the pelvis. The vas meets the gonadal vessels
and the genital branch of the genitofemoral nerve as they approach from
an inferolateral direction and picks up the cremasteric artery as it
branches off the inferior epigastric artery. These comprise the cord
structures that are covered by the internal spermatic fascia, formed from
the connective tissue of the transversalis fascia. Fibers from the internal
oblique form a second covering of the cord, the cremaster muscle, and
cremasteric fascia. In the female, the internal ring transmits the round
ligament, which suspends the uterus anteriorly, and the genital branch of
the genitofemoral nerve. The cord structures that approach and pass
© Springer International Publishing Switzerland 2016
B.P. Jacob et al. (eds.), The SAGES Manual of Groin Pain,
DOI 10.1007/978-3-319-21587-7_2
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