{"id":24570,"date":"2025-07-09T15:41:58","date_gmt":"2025-07-09T14:41:58","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=24570"},"modified":"2026-04-22T13:52:08","modified_gmt":"2026-04-22T12:52:08","slug":"groin-pain-2","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/adult-non-arthritic-hip-service\/groin-pain-2\/","title":{"rendered":"Groin pain"},"content":{"rendered":"\n<p><strong>Possible MSK causes of groin pain<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Hip OA<\/li>\n\n\n\n<li>Hip dysplasia <em>(developmental changes in shape of the hip socket (acetabulum) seen on XR that can lead to symptoms.&nbsp; Acetabulum is more shallow)<\/em><\/li>\n\n\n\n<li>Femoro-acetabular impingement syndrome (FAIS) <em>(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)<\/em><\/li>\n\n\n\n<li>Iliopsoas tendinopathy or inflammation <em>(often presents as pain in central\/lateral groin on kicking \/lifting leg up stairs, due to overuse). <\/em>May be associated with internal snapping hip<em> (deep clunking +\/-pain deep in groin)<\/em><\/li>\n\n\n\n<li>Pubic related <em>(pain in region of pubic symphysis)<\/em><\/li>\n\n\n\n<li>Internal snapping hip<\/li>\n\n\n\n<li>Frozen hip <em>(stiffness in hip joint \u2013 independent of the presence of OA) (Similar to frozen shoulder)<\/em><\/li>\n\n\n\n<li>Hip related groin pain without bony morphology \u2013 labral, chondral damage<\/li>\n\n\n\n<li>Adductor related groin pain<\/li>\n<\/ul>\n\n\n\n<p><strong>History<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Can be traumatic or repetitive in onset, or following increase in training<\/li>\n\n\n\n<li>May have joint hypermobility<\/li>\n<\/ul>\n\n\n\n<p><strong>Signs<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Sharp catching central\/lateral groin pain<\/li>\n\n\n\n<li>\u2018C\u2019 sign \u2013 patient puts thumb on site of pain and index finger further lateral indicating pain deep between the two<\/li>\n<\/ul>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>It is useful when referring to describe the <em>main site <\/em>of groin symptoms:<\/p>\n\n\n\n<p><strong>Adductor<\/strong> \u2013 adductor tenderness and pain on resisted adduction<\/p>\n\n\n\n<p><strong>Iliopsoas<\/strong> \u2013 iliopsoas tenderness, pain on resisted hip flexion AND\/OR pain on hip flexor stretching<\/p>\n\n\n\n<p><strong>Inguinal<\/strong> \u2013 pain in inguinal canal AND tenderness of inguinal canal, without hernia, aggravated by resisted abdominals or Valsalva\/cough\/sneeze<\/p>\n\n\n\n<p><strong>Pubic<\/strong>&nbsp; &#8211; local tenderness of pubic symphysis and immediately adjacent bone<\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"922\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/groin-pain-types-final-1024x922.jpg\" alt=\"groin pain types\" class=\"wp-image-25209\" style=\"width:576px;height:auto\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/groin-pain-types-final-1024x922.jpg 1024w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/groin-pain-types-final-300x270.jpg 300w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/groin-pain-types-final-768x691.jpg 768w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/groin-pain-types-final-1536x1382.jpg 1536w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/groin-pain-types-final-2048x1843.jpg 2048w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/groin-pain-types-final-1267x1140.jpg 1267w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><figcaption><span class=\"media-credit\">NHS Lothian<\/span><\/figcaption><\/figure>\n<\/div>\n\n\n<h4 class=\"wp-block-heading\">Who can refer:<\/h4>\n\n\n\n<p>GPs, GPAPPs, other Consultants<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<p>Patients without OA on XR who have failed to improve despite at least 3 months of targeted hip specific physiotherapy<em><\/em><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<p>If OA is seen on XR \u2013 AP pelvis, refer to <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/arthroplasty\/\" target=\"_blank\" rel=\"noreferrer noopener\">Arthroplasty <\/a><\/p>\n\n\n\n<p>&nbsp;Red flags for groin pain: <em>see home page<\/em><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/adult-non-arthritic-hip-service\/\"> <\/a><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/adult-non-arthritic-hip-service\/\" target=\"_blank\" rel=\"noreferrer noopener\">Adult Non Arthritic Hip Service \u2013 RefHelp<\/a><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<p><strong>SCI gateway &gt; Lauriston Buildings &gt; Orthopaedics \u2013 Hip &gt; LI Adult Non Arthritic Hips\u00a0<\/strong><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><strong>Primary care investigations<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>XR AP pelvis (to assess for OA, dysplasia and bony morphology of hip)<\/li>\n<\/ul>\n\n\n\n<p><strong>Primary care treatment<\/strong><\/p>\n\n\n\n<p>Physiotherapy referral for at least 3 months of targeted hip specific physiotherapy<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><a href=\"https:\/\/www.edinburghorthopaedics.org\/patient-information-pages\/hip\/\" target=\"_blank\" rel=\"noreferrer noopener\">Edinburgh Orthopaedics<\/a> <\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Possible MSK causes of groin pain History Signs<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":24555,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[1268],"class_list":["post-24570","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-groin-pain-2"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/orthopaedics\/https-apps-nhslothian-scot-refhelp-adult-non-arthritic-hip-service\/https-apps-nhslothian-scot-refhelp-groin-pain-2\/\" rel=\"tag\">Groin pain<\/a>","rttpg_excerpt":"Possible MSK causes of groin pain History Signs","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/24570","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=24570"}],"version-history":[{"count":6,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/24570\/revisions"}],"predecessor-version":[{"id":27725,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/24570\/revisions\/27725"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/24555"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=24570"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=24570"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}