Groin pain

Last reviewed: 25 Aug 2023
Last updated: 20 May 2020



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
More key diagnostic factors

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
Other diagnostic factors

Risk factors

  • previous groin injury
  • female sex
  • training background
  • age and sports experience
  • overweight
  • decreased range of motion of the hip
  • muscle strength
More risk factors

Diagnostic investigations

1st investigations to order

  • plain radiographs (anteroposterior [AP] pelvis and AP and lateral hip)
More 1st investigations to order

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 anesthetic agent
More investigations to consider

Treatment algorithm


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.

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



CG declares that he has no competing interests.

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