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Diseases

Groin pain

OVERVIEW

  • Highlights & Basics
  • Images

DIAGNOSIS

  • Diagnostic Approach
  • Risk Factors
  • History & Exam
  • Tests
  • Differential Diagnosis
  • Criteria
  • Screening

TREATMENT

  • Tx Approach
  • Tx Options
  • Emerging Tx
  • Prevention

FOLLOW-UP

  • Overview
  • Complications

REFERENCES

  • Citations
  • Guidelines
  • Credits

PATIENT RESOURCES

  • Patient Instructions

Highlights & Basics

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Key Highlights
  • Groin pain is a very common injury resulting from physical activity, including sports. Most common is adductor-related, iliopsoas-related, inguinal-related, and hip-joint-related groin pain.

  • Intra-articular pathology of the hip joint presents itself as groin pain in most cases. Referred pain from other sources is not uncommon. 

  • Signs and symptoms typically include activity-related pain, pain with movement of the hip, and antalgic gait.

  • The first-line imaging test for most conditions is a set of standard radiographs. More advanced imaging modalities, such as computed tomography, ultrasound, and MRI, should be used with discretion when clinically indicated.

  • Establishing the correct diagnosis is the first step to instituting appropriate treatment. Treatment may vary widely depending on the disease entity present.

MRI demonstrating inferior right femoral neck stress fracture (compression-sided)
MRI demonstrating inferior right femoral neck stress fracture (compression-sided)
From the collection of Cedric J. Ortiguera, MD

Quick Reference

  • History & Exam

    • Key Factors

      • Other Factors

        More information...
      • Diagnostics Tests

          More information...
        • Treatment Options

            More information...

          Definition

          Epidemiology

          Etiology

          Pathophysiology

          content by BMJ Group
          Last updated

          Images

          • Positive Trendelenburg sign

            Positive Trendelenburg sign

          • MRI demonstrating inferior right femoral neck stress fracture (compression-sided)

            MRI demonstrating inferior right femoral neck stress fracture (compression-sided)

          • Metastatic lesion of the femoral neck seen on CT

            Metastatic lesion of the femoral neck seen on CT

          • Osteonecrosis of the right femoral head seen on MRI

            Osteonecrosis of the right femoral head seen on MRI

          Citations

            Key Articles

            • European Society of Sports Traumatology, Knee Surgery and Arthroscopy. A formal ESSKA-EHPA-ESMA consensus: hip and groin pain in physically active adults. Oct 2024 [internet publication].[Full Text]

            • Hölmich P. Adductor-related groin pain in athletes. Sports Med Arthrosc. 1997;5:285-291.

            • Hölmich P, Uhrskou P, Ulnits L, et al. Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: randomized trial. Lancet. 1999;353:439-443.[Abstract]

            Referenced Articles

            • 1. European Society of Sports Traumatology, Knee Surgery and Arthroscopy. A formal ESSKA-EHPA-ESMA consensus: hip and groin pain in physically active adults. Oct 2024 [internet publication].[Full Text]

            • 2. Weir A, Brukner P, Delahunt E, et al. Doha agreement meeting on terminology and definitions in groin pain in athletes. Br J Sports Med. 2015;49:768-774.[Abstract][Full Text]

            • 3. Karlsson J, Sward L, Kalebo P, et al. Chronic groin injuries in athletes: recommendations for treatment and rehabilitation. Sports Med. 1994;17:141-148.[Abstract]

            • 4. Renstrom P, Peterson L. Groin injuries in athletes. Br J Sports Med. 1980;14:30-36.[Abstract]

            • 5. Hölmich P. Adductor-related groin pain in athletes. Sports Med Arthrosc. 1997;5:285-291.

            • 6. Robertson BA, Barker PJ, Fahrer M, et al. The anatomy of the pubic region revisited: implications for the pathogenesis and clinical management of chronic groin pain in athletes. Sports Med. 2009;39:225-234.[Abstract]

            • 7. Werner J, Hägglund M, Waldén M, et al. UEFA injury study: a prospective study of hip and groin injuries in professional football over seven consecutive seasons. Br J Sports Med. 2009;43:1036-40.[Abstract]

            • 8. Hölmich P, Thorborg K, Dehlendorff C, et al. Incidence and clinical presentation of groin injuries in sub-elite male soccer. Br J Sports Med. Br J Sports Med. 2014;48:1245-50.[Abstract]

            • 9. Branci S, Thorborg K, Bech BH, et al. MRI findings in soccer players with long-standing adductor-related groin pain and asymptomatic controls. Br J Sports Med. 2015;49:681-691.[Abstract]

            • 10. Hölmich P, Maffey L, Emery C. Preventing groin injuries. In: Bahr ED, Engebretsen L, eds. Sports injury prevention (Olympic handbook of sports medicine). Lausanne, Switzerland: IOC Medical Commission; 2009:81-117.

            • 11. Whittaker JL, Small C, Maffey L, et al. Risk factors for groin injury in sport: an updated systematic review. Br J Sports Med. 2015 Jun;49(12):803-9.[Abstract]

            • 12. Tak I, Engelaar L, Gouttebarge V, et al. Is lower hip range of motion a risk factor for groin pain in athletes? A systematic review with clinical applications. Br J Sports Med. 2017 Nov;51(22):1611-21.[Abstract][Full Text]

            • 13. Expert Panel on Musculoskeletal Imaging, Jawetz ST, Fox MG, et al. ACR appropriateness criteria® chronic hip pain: 2022 update. J Am Coll Radiol. 2023 May;20(5s):S33-48.[Abstract]

            • 14. Eberbach H, Fürst-Meroth D, Kloos F, et al. Long-standing pubic-related groin pain in professional academy soccer players: a prospective cohort study on possible risk factors, rehabilitation and return to play. BMC Musculoskelet Disord. 2021 Nov 17;22(1):958.[Abstract][Full Text]

            • 15. Reiman MP, Agricola R, Kemp JL, et al. Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018. Br J Sports Med. 2020 Jun;54(11):631-41.[Abstract][Full Text]

            • 16. Trendelenburg F. Trendelenburg's test: Friedrich Trendelenburg, 1844-1924. In: Rang M, ed. Anthology of orthopaedics. Edinburgh: E&S Livingstone Ltd; 1966:139-43.

            • 17. Hölmich P, Hölmich LR, Bjerg AM. Clinical examination of athletes with groin pain: an intraobserver and interobserver reliability study. Br J Sports Med. 2004;38:446-451.[Abstract][Full Text]

            • 18. Czerny C, Hofmann S, Urban M, et al. Lesions of the acetabular labrum: accuracy of MR imaging and MR arthrography in detection and staging. Radiology. 1996;200:225-230.[Abstract]

            • 19. Keeney JA, Peelle MW, Jackson J, et al. Magnetic resonance arthrography versus arthroscopy in evaluation of articular hip pathology. Clin Orthop Relat Res. 2004;429:163-169.[Abstract]

            • 20. Bas S, Perneger TV, Seitz M, et al. Diagnostic tests for rheumatoid arthritis: comparison of anti-cyclic citrullinated peptide antibodies, anti-keratin antibodies and IgM rheumatoid factors. Rheumatology (Oxford). 2002;41:809-814.[Abstract][Full Text]

            • 21. Huang AB, Schweitzer ME, Hume E, et al. Osteomyelitis of the pelvis/hips in paralyzed patients: accuracy and clinical utility of MRI. J Comput Assist Tomogr. 1998;22:437-443.[Abstract]

            • 22. Hölmich P, Uhrskou P, Ulnits L, et al. Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: randomized trial. Lancet. 1999;353:439-443.[Abstract]

            • 23. Schilders E, Dimitrakopoulou A, Cooke M, et al. Effectiveness of a selective partial adductor release for chronic adductor-related groin pain in professional athletes. Am J Sports Med. 2013;41:603-607.[Abstract]

            • 24. Westlin N. Groin pain in athletes from Southern Sweden. Sports Med Arthrosc. 1997;5:280-284.

            • 25. Banerjee P, McLean CR. Femoroacetabular impingement: a review of diagnosis and management. Curr Rev Musculoskelet Med. 2011;4:23-32.[Abstract][Full Text]

            • 26. Pihlajamaki HK, Ruohola JP, Kiuru MJ, et al. Displaced femoral neck fatigue fractures in military recruits. J Bone Joint Surg. 2006;88:1989-1997.[Abstract]

            • 27. Lee CH, Huang GS, Chao KH, et al. Surgical treatment of displaced stress fracture of the femoral neck in military recruits: a report of 42 cases. Arch Orthop Trauma Surg. 2003;123:527-533.[Abstract]

            • 28. Akermark C, Johansson C. Tenotomy of the adductor longus tendon in the treatment of chronic groin pain in athletes. Am J Sports Med. 1992;20:640-643.[Abstract]

            • 29. Hölmich P, Nyvold P, Larsen K. Continued significant effect of physical training as treatment for overuse injury: 8- to 12-year outcome of a randomized clinical trial. Am J Sports Med. 2011;39:2447-2451.[Abstract]

            • 30. Brudvig TJ, Gudger TD, Obermeyer L. Stress fractures in 295 trainees: a one year study of incidence as related to age, sex, and race. Mil Med. 1983;148:666-7.[Abstract]

            • 31. Thorborg K, Hölmich P, Christensen R, et al. The Copenhagen Hip and Groin Outcome Score (HAGOS): development and validation according to the COSMIN checklist. Br J Sports Med. 2011;45:478-91.[Abstract]

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