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Hip PainAka: Groin Pain, Groin Injury, Groin Injuries in Athletes

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Epidemiology: Groin Injury in Athletes
1. Groin injury accounts for 2-5% of sports injury
2. Higher risk sports for groin injury
  1. Soccer (Incidence 5-7%)
  2. Ice hockey
  3. Fencing
  4. Handball
  5. Cross Country Skiing
  6. Hurdling
  7. High Jumping
Causes: Common pearls by location
1. Groin Pain
  1. Consider Intra-articular hip pain
2. Lateral Pain
  1. Trochanteric Bursitis
3. Buttock Pain
  1. Referred pain from lumbosacral spine
  2. Sacroiliac joint
  3. Piriformis Syndrome (deep pain worse with sitting)
Causes: Anterior Hip Pain
1. Spontaneous onset without trauma in elderly
  1. Consider inflammatory arthritis, infection
  2. Ask about systemic symptoms
  3. Start evaluation with CBC, ESR, RF
2. Insidious onset in elderly
  1. Risks: age >65, ROM pain, cancer, trauma, Alcohol
  2. Start with Hip XRay
    1. Evaluate for Osteoarthritis
    2. Consider Avascular necrosis, tumor or Fracture
3. Overuse or sports related anterior hip pain
  1. Clicking or Snapping Hip
    1. Tests: Thomas Test or Snapping Hip maneuver
    2. Common Diagnoses (See Snapping Hip)
      1. Iliopsoas Bursitis
      2. Labral tear
  2. Suspected Stress Fracture
    1. Obtain MRI
    2. Non-weight bearing
  3. Resisted muscle testing and local tenderness
    1. Consider hip flexor Muscle Strain
Causes: Lateral Hip Pain
1. Overuse or sports related
  1. Consider Iliotibial Band Syndrome
2. Tender over greater trochanter
  1. Greater Trochanteric Bursitis
3. Tender at gluteus medius, hip abductor weakness/pain
  1. Gluteus medius muscle dysfunction
4. Anterolateral thigh neuropathic pain
  1. Meralgia Paresthetica
Causes: Groin pain or hip pain in athletes
1. Idiopathic in 30% of cases
2. Adductor Strain or Adductor Tendinitis (Groin Pull)
3. Pubic Instability
4. Osteitis Pubis
5. Myositis Ossificans
6. Sports Hernia
7. Groin Disruption
8. Iliopsoas Strain or Iliopsoas Bursitis
9. Snapping Hip syndrome
10. Femoral Neck Stress Fracture
11. Pubic Ramus Stress Fracture
12. Avulsion Fracture (Adolescent Athletes)
  1. Anterior Superior Iliac Spine Avulsion Fracture
    1. Rapid sartorius contraction in jumping sport
    2. Responds to non-operative conservative therapy
  2. Anterior Inferior Iliac Spine Avulsion Fracture
    1. Strong rectus femoris contraction in kicking sport
    2. Responds to non-operative conservative therapy
  3. Ischial Tuberosity Avulsion Fracture
    1. Rapid hamstring contraction in sprinting, hurdling
    2. Fragments >1-2 cm may require ORIF
13. Nerve entrapment
  1. Genitofemoral nerve entrapment
  2. Lateral Femoral Cutaneous Nerve Entrapment
  3. Ilioinguinal Nerve Entrapment
  4. Obturator Nerve Entrapment
Causes: Hip joint disorders with groin or hip pain by age
1. Pediatric Causes (under age 10 years)
  1. See Pediatric Limp
  2. Legg-Calve-Perthes Disease
  3. Septic Joint
  4. Toxic Synovitis
2. Adolescent causes
  1. Slipped Capital Femoral Epiphysis
  2. Hip Avulsion Fracture
3. Adult causes (See causes below)
  1. Osteoarthritis of femoral head
  2. Avascular necrosis of the femoral head
  3. Acetabular labral tear
Causes: Musculoskeletal causes of groin or hip pain
1. Bone Causes
  1. Hip Fracture
  2. Femoral head avascular necrosis
  3. Cancer (primary site or metastases)
2. Joint Causes
  1. Hip Osteoarthritis
  2. Septic Arthritis
  3. Gouty Arthritis
  4. Osteoid Osteoma
  5. Osteitis Pubis
3. Muscle or tendon Causes
  1. Iliotibial Band Syndrome
  2. Trochanteric Bursitis
  3. Iliopsoas Bursitis
  4. Pyriformis Syndrome
  5. Myositis Ossificans
4. Neurologic Causes
  1. Lumbar Disc Disease
  2. Lumbar Spinal Stenosis
  3. Coccygodynia
  4. Meralgia Paresthetica (see nerve entrapment above)
Causes: Non-musculoskeletal causes of groin or hip pain
1. General
  1. Inguinal Hernia
  2. Inguinal Lymphadenopathy or lymphadenitis
  3. Lumbar Disc Disease with L1-2 radiculopathy
  4. Nephrolithiasis
  5. Abdominal Aortic Aneurysm
  6. Appendicitis
  7. Diverticulitis
  8. Inflammatory Bowel Disease
  9. Malignancy
2. Women
3. Men
References
1. Fields (1997) Lecture: AAFP Sports Medicine, Dallas
2. Ruane (1998) Physician SportsMed 26(4):78-103
3. Brunner (2003) Am Fam Physician 67(3):537
4. Fricker (1997) Br J Sports Med 31:97
5. Lynch (1999) Sports Med 28:137
6. Morelli (2001) Am Fam Physician 64(8):1405

Hip pain (C0019559)
Concepts	Sign or Symptom (T184)
English	Arthralgia of hip, Coxalgia, Hip arthralgia, Hip joint pain, Hip pain, Pain in joint - coxalgia
Spanish	coxalgia, dolor de cadera
Parent Concepts	Bone pain (C0151825), Pain in lower limb (C0023222), [D]Musculoskeletal pain (C0026858), Pelvic Pain (C0030794), Hip joint finding (C0575998), Duplicate concept (C1274013)
Sources	COSTAR, DXP, LNC, NCI, OMIM, SCTSPA, SNOMEDCT Derived from the NIH UMLS (Unified Medical Language System)

Inguinal pain (C0239783)
Concepts	Sign or Symptom (T184)
English	Groin pain, Inguinal pain, Inguinodynia, PAIN GROIN
Spanish	dolor en la ingle, dolor inguinal, inguinodinia
Parent Concepts	Abdominal Pain (C0000737), Pain in lower limb (C0023222), Pelvic Pain (C0030794), Duplicate concept (C1274013)
Sources	CST, DXP, QMR, SCTSPA, SNOMEDCT Derived from the NIH UMLS (Unified Medical Language System)

Injury of groin (C0272438)
Concepts	Injury or Poisoning (T037)
English	Groin injury, Injury of groin
Spanish	injuria de la ingle, injuria inguinal, lesion traumatica de la ingle
Parent Concepts	Abdominal Injuries (C0000733), Leg Injuries (C0023220), Pelvic injury (C0560636), Disorder of inguinal region (C1290868)
Sources	SCTSPA, SNOMEDCT Derived from the NIH UMLS (Unified Medical Language System)

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Foot Disorders

Hand Disorders

Hip Disorders

Knee Disorders

Lumbar Spine Disorders

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Hip PainAka: Groin Pain, Groin Injury, Groin Injuries in Athletes

Hip pain (C0019559)

Inguinal pain (C0239783)

Injury of groin (C0272438)

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