Differential Diagnosis for Groin Pull after Moving an Object Persistent for 3 Months

• Single most likely diagnosis:
  • Adductor strain: This is the most common cause of groin pain in individuals who have recently engaged in physical activity, especially those involving sudden stops, changes of direction, or lifting heavy objects. The persistence of symptoms for 3 months suggests a possible chronic strain or incomplete healing.
• Other Likely diagnoses:
  • Osteitis pubis: An inflammatory condition affecting the pubic bone and surrounding structures, often seen in athletes or individuals with repetitive stress on the groin area. It could be a consideration given the chronic nature of the pain.
  • Stress fracture: A small crack in one of the bones in the groin area, which could occur from overuse or repetitive stress, especially if the individual has recently increased their physical activity level.
  • Hernia: Although less common as a cause of chronic groin pain without a palpable bulge, it should be considered, especially if there are symptoms of discomfort or pain that worsen with coughing, sneezing, or straining.
• Do Not Miss diagnoses:
  • Testicular torsion: Although typically presents acutely, any condition causing severe groin pain should prompt consideration of testicular torsion, especially if the pain is severe and of sudden onset. However, the chronic nature of the pain in this case makes it less likely.
  • Avascular necrosis of the femoral head: A condition where the blood supply to the head of the femur is disrupted, leading to bone death. It's a rare but serious condition that could present with groin pain and should be considered, especially if there's a history of steroid use, excessive alcohol consumption, or significant trauma.
  • Inguinal lymphadenopathy: Enlarged lymph nodes in the groin area could indicate a systemic infection or malignancy. While less likely, it's crucial not to miss such conditions due to their potential severity.
• Rare diagnoses:
  • Avulsion fracture: A fracture where a fragment of bone is pulled away by a tendon or ligament, which could occur in the groin area, especially in younger athletes.
  • Slipped capital femoral epiphysis (SCFE): A condition where the growth plate in the hip joint becomes displaced, more common in adolescents but could be considered in younger individuals with groin pain.
  • Psoas abscess: A rare condition where an abscess forms in the psoas muscle, which could cause groin pain, typically accompanied by other systemic symptoms like fever and malaise.