Possible MSK causes of groin pain
- Hip OA
- Hip dysplasia (developmental changes in shape of the hip socket (acetabulum) seen on XR that can lead to symptoms. Acetabulum is more shallow)
- Femoro-acetabular impingement syndrome (FAIS) (pinching or catching in the groin from symptomatic contact of the femur on the acetabulum or soft tissues- diagnosed by symptoms, signs and imaging findings)
- Iliopsoas tendinopathy or inflammation (often presents as pain in central/lateral groin on kicking /lifting leg up stairs, due to overuse). May be associated with internal snapping hip (deep clunking +/-pain deep in groin)
- Pubic related (pain in region of pubic symphysis)
- Internal snapping hip
- Frozen hip (stiffness in hip joint – independent of the presence of OA) (Similar to frozen shoulder)
- Hip related groin pain without bony morphology – labral, chondral damage
- Adductor related groin pain
- Pelvic insufficiency fracture in osteoporotic patients
History
- Can be traumatic or repetitive in onset, or following increase in training
- May have joint hypermobility
Signs
- Sharp catching central/lateral groin pain
- ‘C’ sign – patient puts thumb on site of pain and index finger further lateral indicating pain deep between the two
It is useful when referring to describe the main site of groin symptoms:
Adductor – adductor tenderness and pain on resisted adduction
Iliopsoas – iliopsoas tenderness, pain on resisted hip flexion AND/OR pain on hip flexor stretching
Inguinal – pain in inguinal canal AND tenderness of inguinal canal, without hernia, aggravated by resisted abdominals or Valsalva/cough/sneeze
Pubic – local tenderness of pubic symphysis and immediately adjacent bone
Who can refer:
GPs, GPAPPs, other Consultants
Who to refer:
Patients without OA on XR who have failed to improve despite at least 3 months of targeted hip specific physiotherapy
Who not to refer:
If OA is seen on XR – AP pelvis, refer to Arthroplasty –link to Arthroplasty
Red flags for groin pain: see home page
How to refer:
SCI gateway > Laurison Buildings > Orthopaedics – Other (Please note that the SCI gateway pathway will change soon to ANAH – Adult Non-Arthritic Hip)
Primary care investigations
- XR AP pelvis (to assess for OA, dysplasia and bony morphology of hip)
Primary care treatment
Physiotherapy referral for at least 3 months of targeted hip specific physiotherapy
