Differential Diagnosis for Groin Pain in Athletes

The following is a differential diagnosis for groin pain in athletes, categorized for clarity and emphasis on critical conditions.

• Single Most Likely Diagnosis

  • Adductor Strain: This is the most common cause of groin pain in athletes, particularly those involved in sports that require sudden changes of direction, such as soccer, football, and hockey. The adductor muscles are prone to strain due to their role in hip flexion and abduction.

• Other Likely Diagnoses

  • Osteitis Pubis: Inflammation of the pubic bone and its surrounding structures, often seen in athletes who participate in sports involving repetitive kicking, such as soccer. It can cause chronic groin pain.
  • Stress Fracture: Stress fractures of the pubic rami or femoral neck can cause groin pain in athletes, especially those with sudden increases in training intensity or frequency.
  • Hip Flexor Strain: The hip flexor muscles, including the iliopsoas, can be strained during athletic activities, leading to groin pain.
  • Inguinal Hernia: Though more common in non-athletic populations, inguinal hernias can occur in athletes and cause groin pain, especially with coughing, lifting, or straining.

• Do Not Miss Diagnoses

  • Testicular Torsion: A medical emergency that requires immediate attention. It can present with sudden, severe groin pain and is more common in younger males.
  • Epididymitis: Inflammation of the epididymis, which can cause severe groin pain and is often associated with urinary symptoms.
  • Appendicitis: Though the appendix is located in the lower right abdomen, an inflamed appendix can sometimes refer pain to the groin area, especially if it is retrocecal (located behind the cecum).
  • Avulsion Fracture: A fracture where a fragment of bone is pulled off by a tendon or ligament, which can occur in the groin area and requires prompt medical attention.

• Rare Diagnoses

  • Sportsman's Hernia (Gilmore's Groin): A condition characterized by a dilatation of the external inguinal ring and a tear in the conjoint tendon, without a palpable hernia. It's a rare cause of chronic groin pain in athletes.
  • Pudendal Nerve Entrapment: Entrapment of the pudendal nerve can cause chronic pain in the groin area, perineum, and genitalia, though it is less common in athletes.
  • Avascular Necrosis of the Femoral Head: Though not exclusively a groin pain condition, avascular necrosis can cause hip pain that may radiate to the groin and is a concern in athletes, especially those with a history of steroid use or significant trauma.