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Differential Diagnosis of Groin Pain in Athletes

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Sports Hernia and Athletic Pubalgia

Abstract

Groin pain is a common complaint in athletes, particularly among those participating in kicking and pivoting sports. Groin pain can arise from a wide variety of causes, or some combination thereof, ranging from musculoskeletal disorders to abdominal and genitourinary pathology. Many causes of groin pain in the athlete are found in the hip, both extra- and intra-articular. Muscle tendon disorders of the adductor and hip flexor groups are common extra-articular sources of groin pain in athletes. Sports hernia, osteitis pubis, and sacroiliac joint dysfunction are also part of the differential diagnosis, as are nerve injuries and stress fractures. Common intra-articular causes of groin pain in the athlete include labral tears and femoroacetabular impingement (FAI). Arriving at the correct diagnosis depends on keeping an open mind while collecting a careful history and conducting a thorough physical examination. Imaging can help and is often necessary. Additional diagnostics such as EMG and nerve conduction studies may be required.

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References

  1. Macintyre J, Johson C, Schroeder EL. Groin pain in athletes. Curr Sports Med Rep. 2006;5(6):293–9.

    Article  PubMed  Google Scholar 

  2. Fricker PA, Taunton JE, Ammann W. Osteitis pubis in athletes. Infection, inflammation or injury? Sports Med. 1991;12(4):266–79.

    Article  CAS  PubMed  Google Scholar 

  3. Koch RA, Jackson DW. Pubic symphysitis in runners. A report of two cases. Am J Sports Med. 1981;9(1):62–3.

    Article  CAS  PubMed  Google Scholar 

  4. Roos HP. Hip pain in sport. Sports Med Arthrosc Rev. 1997;5(4):292–300.

    Google Scholar 

  5. Ekberg O, Persson NH, Abrahamsson PA, Westlin NE, Lilja B. Longstanding groin pain in athletes. A multidisciplinary approach. Sports Med. 1988;6(1):56–61.

    Article  CAS  PubMed  Google Scholar 

  6. Lovell G. The diagnosis of chronic groin pain in athletes: a review of 189 cases. Aust J Sci Med Sport. 1995;27(3):76–9.

    CAS  PubMed  Google Scholar 

  7. DonTigny RL. Function and pathomechanics of the sacroiliac joint. A review. Phys Ther. 1985;65(1):35–44.

    CAS  PubMed  Google Scholar 

  8. DonTigny RL. Anterior dysfunction of the sacroiliac joint as a major factor in the etiology of idiopathic low back pain syndrome. Phys Ther. 1990;70(4):250–65. discussion 262–255.

    CAS  PubMed  Google Scholar 

  9. DonTigny RL. Critical analysis of the sequence and extent of the result of the pathological release of self-bracing of the sacroiliac joint. J Orthop Med. 2000;22:16–23.

    Google Scholar 

  10. DonTigny RL. Clinical analysis of the functional dynamics of the sacroiliac joints as they pertain to normal gail. J Orthop Med. 2005;27:3–10.

    Google Scholar 

  11. DonTigny RL. Pathology of the sacroiliac joint, its effect on normal gait and its correction. J Orthop Med. 2005;27:61–9.

    Google Scholar 

  12. DonTigny RL. A detailed and critical biomechanical analysis of the sacroiliac joints and relevant kinesiology. The implications for lumbopelvic function and dysfunction. In: Vleeming A, Mooney V, Stoeckart R, editors. Movement, stability & lumbopelvic pain: integration of research and therapy. 2nd ed. Philadelphia: Churchill Livingstone; 2007. p. 265–78.

    Google Scholar 

  13. Pool-Goudzwaard AL, Vleeming A, Stoeckart R, Snijders CJ, Mens JM. Insufficient lumbopelvic stability: a clinical, anatomical and biomechanical approach to ‘a-specific’ low back pain. Man Ther. 1998;3(1):12–20.

    Article  PubMed  Google Scholar 

  14. Vleeming A, Pool-Goudzwaard AL, Hammudoghlu D, Stoeckart R, Snijders CJ, Mens JM. The function of the long dorsal sacroiliac ligament: its implication for understanding low back pain. Spine. 1996;21(5):556–62.

    Article  CAS  PubMed  Google Scholar 

  15. Vleeming A, Stoeckart R, Volkers AC, Snijders CJ. Relation between form and function in the sacroiliac joint. Part I: clinical anatomical aspects. Spine. 1990;15(2):130–2.

    Article  CAS  PubMed  Google Scholar 

  16. Vleeming A, Volkers AC, Snijders CJ, Stoeckart R. Relation between form and function in the sacroiliac joint. Part II: biomechanical aspects. Spine. 1990;15(2):133–6.

    Article  CAS  PubMed  Google Scholar 

  17. Blankenbaker DG, Tuite MJ. Iliopsoas musculotendinous unit. Semin Musculoskelet Radiol. 2008;12(1):13–27.

    Article  PubMed  Google Scholar 

  18. Nelson EN, Kassarjian A, Palmer WE. MR imaging of sports-related groin pain. Magn Reson Imaging Clin N Am. 2005;13(4):727–42.

    Article  PubMed  Google Scholar 

  19. Johnston CA, Wiley JP, Lindsay DM, Wiseman DA. Iliopsoas bursitis and tendinitis. A review. Sports Med. 1998;25(4):271–83.

    Article  CAS  PubMed  Google Scholar 

  20. Schaberg JE, Harper MC, Allen WC. The snapping hip syndrome. Am J Sports Med. 1984;12(5):361–5.

    Article  CAS  PubMed  Google Scholar 

  21. Jacobson T, Allen WC. Surgical correction of the snapping iliopsoas tendon. Am J Sports Med. 1990;18(5):470–4.

    Article  CAS  PubMed  Google Scholar 

  22. Lyons JC, Peterson LF. The snapping iliopsoas tendon. Mayo Clin Proc. 1984;59(5):327–9.

    Article  CAS  PubMed  Google Scholar 

  23. Rotini R, Spinozzi C, Ferrari A. Snapping hip: a rare form with internal etiology. Ital J Orthop Traumatol. 1991;17(2):283–8.

    CAS  PubMed  Google Scholar 

  24. Janzen DL, Partridge E, Logan PM, Connell DG, Duncan CP. The snapping hip: clinical and imaging findings in transient subluxation of the iliopsoas tendon. Can Assoc Radiol J. 1996;47(3):202–8.

    CAS  PubMed  Google Scholar 

  25. Tibor LM, Sekiya JK. Differential diagnosis of pain around the hip joint. Arthroscopy. 2008;24(12): 1407–21.

    Article  PubMed  Google Scholar 

  26. Ekstrand J, Gillquist J. The avoidability of soccer injuries. Int J Sports Med. 1983;4(2):124–8.

    Article  CAS  PubMed  Google Scholar 

  27. Sim FH, Chao EY. Injury potential in modern ice hockey. Am J Sports Med. 1978;6(6):378–84.

    Article  CAS  PubMed  Google Scholar 

  28. Nicholas SJ, Tyler TF. Adductor muscle strains in sport. Sports Med. 2002;32(5):339–44.

    Article  PubMed  Google Scholar 

  29. Renstrom P, Peterson L. Groin injuries in athletes. Br J Sports Med. 1980;14(1):30–6.

    Article  CAS  PubMed  Google Scholar 

  30. Maffey L, Emery C. What are the risk factors for groin strain injury in sport? A systematic review of the literature. Sports Med. 2007;37(10):881–94.

    Article  PubMed  Google Scholar 

  31. Vogt S, Ansah P, Imhoff AB. Complete osseous avulsion of the adductor longus muscle: acute repair with three fiberwire suture anchors. Arch Orthop Trauma Surg. 2007;127(8):613–5.

    Article  PubMed  Google Scholar 

  32. Schilders E, Bismil Q, Robinson P, O’Connor PJ, Gibbon WW, Talbot JC. Adductor-related groin pain in competitive athletes. Role of adductor enthesis, magnetic resonance imaging, and entheseal pubic cleft injections. J Bone Joint Surg Am. 2007;89(10): 2173–8.

    Article  PubMed  Google Scholar 

  33. Farber AJ, Wilckens JH. Sports hernia: diagnosis and therapeutic approach. J Am Acad Orthop Surg. 2007;15(8):507–14.

    PubMed  Google Scholar 

  34. Meyers WC, Foley DP, Garrett WE, Lohnes JH, Mandlebaum BR. Management of severe lower abdominal or inguinal pain in high-performance athletes. PAIN (Performing Athletes with Abdominal or Inguinal Neuromuscular Pain Study Group). Am J Sports Med. 2000;28(1):2–8.

    CAS  PubMed  Google Scholar 

  35. Nepple JJ, Brophy RH, Matava MJ, Wright RW, Clohisy JC. Radiographic findings of femoroacetabular impingement in National Football League combine athletes undergoing radiographs for previous hip or groin pain. Arthroscopy. 2012;28(10): 1396–403.

    Article  PubMed  Google Scholar 

  36. van Veen RN, de Baat P, Heijboer MP, et al. Successful endoscopic treatment of chronic groin pain in athletes. Surg Endosc. 2007;21(2):189–93.

    Article  PubMed  Google Scholar 

  37. Joesting DR. Diagnosis and treatment of sportsman’s hernia. Curr Sports Med Rep. 2002;1(2):121–4.

    Article  PubMed  Google Scholar 

  38. Meyers WC, Lanfranco A, Castellanos A. Surgical management of chronic lower abdominal and groin pain in high-performance athletes. Curr Sports Med Rep. 2002;1(5):301–5.

    Article  PubMed  Google Scholar 

  39. Paajanen H, Hermunen H, Karonen J. Pubic magnetic resonance imaging findings in surgically and conservatively treated athletes with osteitis pubis compared to asymptomatic athletes during heavy training. Am J Sports Med. 2008;36(1):117–21.

    Article  PubMed  Google Scholar 

  40. Radic R, Annear P. Use of pubic symphysis curettage for treatment-resistant osteitis pubis in athletes. Am J Sports Med. 2008;36(1):122–8.

    Article  PubMed  Google Scholar 

  41. Verrall GM, Slavotinek JP, Barnes PG, Esterman A, Oakeshott RD, Spriggins AJ. Hip joint range of motion restriction precedes athletic chronic groin injury. J Sci Med Sport. 2007;10(6):463–6.

    Article  PubMed  Google Scholar 

  42. Mehin R, Meek R, O’Brien P, Blachut P. Surgery for osteitis pubis. Can J Surg. 2006;49(3):170–6.

    PubMed Central  PubMed  Google Scholar 

  43. McCrory P, Bell S. Nerve entrapment syndromes as a cause of pain in the hip, groin and buttock. Sports Med. 1999;27(4):261–74.

    Article  CAS  PubMed  Google Scholar 

  44. Bradshaw C, McCrory P, Bell S, Brukner P. Obturator nerve entrapment. A cause of groin pain in athletes. Am J Sports Med. 1997;25(3):402–8.

    Article  CAS  PubMed  Google Scholar 

  45. Fortin JD, Dwyer AP, West S, Pier J. Sacroiliac joint: pain referral maps upon applying a new injection/arthrography technique. Part I: asymptomatic volunteers. Spine. 1994;19(13):1475–82.

    Article  CAS  PubMed  Google Scholar 

  46. Slipman CW, Jackson HB, Lipetz JS, Chan KT, Lenrow D, Vresilovic EJ. Sacroiliac joint pain referral zones. Arch Phys Med Rehabil. 2000;81(3):334–8.

    Article  CAS  PubMed  Google Scholar 

  47. Rumball JS, Lebrun CM, Di Ciacca SR, Orlando K. Rowing injuries. Sports Med. 2005;35(6):537–55.

    Article  PubMed  Google Scholar 

  48. Timm KE. Sacroiliac joint dysfunction in elite rowers. J Orthop Sports Phys Ther. 1999;29(5):288–93.

    Article  CAS  PubMed  Google Scholar 

  49. Prather H. Sacroiliac joint pain: practical management. Clin J Sport Med. 2003;13(4):252–5.

    Article  PubMed  Google Scholar 

  50. Binningsley D. Tear of the acetabular labrum in an elite athlete. Br J Sports Med. 2003;37(1):84–8.

    Article  CAS  PubMed  Google Scholar 

  51. Narvani AA, Tsiridis E, Kendall S, Chaudhuri R, Thomas P. A preliminary report on prevalence of acetabular labrum tears in sports patients with groin pain. Knee Surg Sports Traumatol Arthrosc. 2003;11(6): 403–8.

    Article  CAS  PubMed  Google Scholar 

  52. Saw T, Villar R. Footballer’s hip a report of six cases. J Bone Joint Surg Br. 2004;86(5):655–8.

    Article  CAS  PubMed  Google Scholar 

  53. Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–20.

    PubMed  Google Scholar 

  54. McCarthy J, Noble P, Aluisio FV, Schuck M, Wright J, Lee JA. Anatomy, pathologic features, and treatment of acetabular labral tears. Clin Orthop Relat Res. 2003;406:38–47.

    Article  PubMed  Google Scholar 

  55. McCarthy JC, Noble PC, Schuck MR, Wright J, Lee J. The Otto E. Aufranc Award: the role of labral lesions to development of early degenerative hip disease. Clin Orthop Relat Res. 2001;393:25–37.

    Article  PubMed  Google Scholar 

  56. Peelle MW, Della Rocca GJ, Maloney WJ, Curry MC, Clohisy JC. Acetabular and femoral radiographic abnormalities associated with labral tears. Clin Orthop Relat Res. 2005;441:327–33.

    Article  PubMed  Google Scholar 

  57. Crawford JR, Villar RN. Current concepts in the management of femoroacetabular impingement. J Bone Joint Surg Br. 2005;87(11):1459–62.

    Article  CAS  PubMed  Google Scholar 

  58. Philippon MJ, Schenker ML. Arthroscopy for the treatment of femoroacetabular impingement in the athlete. Clin Sports Med. 2006;25(2):299–308. ix.

    Article  PubMed  Google Scholar 

  59. Morelli V, Espinoza L. Groin injuries and groin pain in athletes: part 2. Prim Care. 2005;32(1):185–200.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Sports Medicine, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Robert H. Brophy

  2. Physical Medicine and Rehabilitation Section, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Heidi Prather

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  1. Robert H. Brophy
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  2. Heidi Prather
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Correspondence to Robert H. Brophy .

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Editors and Affiliations

  1. Alfred R. Shands Professor of Orthopedic Surgery, Head Orthopedic Team Physician, Director, Sports Medicine Fellowship Program, University of Virginia School of Medicine, Charlottesville, Virginia, USA

    David R. Diduch

  2. Team Surgeon, St. Louis Blues, Professor of Surgery, Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, Missouri, USA

    L. Michael Brunt

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Brophy, R.H., Prather, H. (2014). Differential Diagnosis of Groin Pain in Athletes. In: Diduch, D., Brunt, L. (eds) Sports Hernia and Athletic Pubalgia. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-7421-1_3

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  • DOI: https://doi.org/10.1007/978-1-4899-7421-1_3

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