Summary
Definition
History and exam
Key diagnostic factors
- acute pain related to trauma
- history of sports-related or overuse injury
- positive anterior impingement test (FADIR test)
- pain on adduction against resistance (neutral hip flexion)
- pain on palpation of adductor tendons
- pain on palpation of iliopsoas
Other diagnostic factors
- pain on passive range-of-motion testing of the hip joint
- snapping/clicking hip
- positive Trendelenburg test
- positive apprehension test
- positive modified Thomas test
- pain on palpation of inguinal canal
- pain on palpation of conjoined tendon at pubic tubercle
- decreased strength and increased pain with hip flexion against resistance (90˚)
- night pain/rest pain
Risk factors
- previous groin injury
- female sex
- training background
- age and sports experience
- overweight
- decreased range of motion of the hip
- muscle strength
Diagnostic tests
1st tests to order
- plain radiographs (anteroposterior [AP] pelvis and AP and lateral hip)
Tests to consider
- ultrasound of the hip
- MRI of the hip
- MRI arthrogram of the hip
- CT of the hip
- isotope bone scan of the hip
- intra-articular injection corticosteroid ± local anesthetic agent
Treatment algorithm
femoral neck stress fracture
traumatic or overuse injury: initial presentation
traumatic or overuse injury: not responding to initial management
Contributors
Authors
Per Hölmich, MD, DMSc
Professor of Orthopedic Surgery and Chief Surgeon
Sports Orthopedic Research Center – Copenhagen (SORC-C)
Arthroscopy Centre Hvidovre, Department of Orthopedics
Amager & Hvidovre Hospital
University of Copenhagen
Denmark
Disclosures
PH is an author of a number of references cited in this topic. PH declares that he has no other competing interests.
Acknowledgements
Dr Per Hölmich would like to gratefully acknowledge Dr Cedric J Ortiguera and Dr Juan M Raposo, the previous contributors to this topic. CJO and JMR declare that they have no competing interests.
Peer reviewers
Carlos Guanche, MD
Specialist in Arthroscopy of the Shoulder, Hip, and Knee; Traditional and Reverse Shoulder Replacement; and Sports Medicine
Southern California Orthopedic Institute
Van Nuys
CA
Disclosures
CG declares that he has no competing interests.
References
Key articles
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
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;45:478-491. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Hip dysplasia
- Nerve entrapment
- Ankylosing spondylitis
More Differentials
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