A very common injury resulting from physical activity, including sport. Most common is adductor-related, iliopsoas-related, inguinal-related, and hip-joint-related groin pain.
Most common presentation for intra-articular pathology of the hip joint; however, 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 diagnostic test for most conditions is a set of standard x-rays. More advanced imaging modalities, such as 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.
In select cases, such as stress fracture, failure to recognise and obtain timely surgical consultation can lead to significant morbidity and complications for the patient.
Groin pain is a common presenting symptom for patients of widely varying ages in the primary care setting. Common causes include trauma and overuse injuries. It can also be due to referred pain from non-musculoskeletal sources (e.g., urogenital, gastrointestinal, neurological) . This topic focuses on exercise- and activity-related issues.
History and exam
Key diagnostic factors
- presence of risk 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's 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
- previous groin injury
- female sex
- training background
- age and sports experience
- decreased range of motion of the hip
- muscle strength
1st investigations to order
- plain x-rays (anteroposterior [AP] pelvis and AP and lateral hip)
Investigations 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 anaesthetic agent
femoral neck stress fracture
traumatic or overuse injury: initial presentation
traumatic or overuse injury: not responding to initial management
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
PH is an author of a number of references cited in this topic. PH declares that he has no other competing interests.
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.
Carlos Guanche, MD
Specialist in Arthroscopy of the Shoulder, Hip, and Knee; Traditional and Reverse Shoulder Replacement; and Sports Medicine
Southern California Orthopedic Institute
CG declares that he has no competing interests.
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