From the Guidelines
The workup for a 23-year-old runner with right groin pain should begin with a thorough history and physical examination, including assessment of hip range of motion, strength testing, and palpation of the groin area, as recommended by the International Hip-related Pain Research Network 1.
Initial Evaluation
The history should focus on onset, duration, and exacerbating factors. Initial imaging typically includes plain radiographs of the hip and pelvis to rule out fractures or bony abnormalities, with anteroposterior (AP) pelvis and lateral femoral head–neck radiographs being the recommended initial diagnostic imaging 1.
Further Diagnostic Steps
If the diagnosis remains unclear, an MRI would be the next appropriate imaging study as it can detect soft tissue injuries such as muscle strains, labral tears, or sports hernias. The FADIR test is recommended as the most appropriate clinical measure to potentially screen for all hip-related pain, despite its limitations 1.
Laboratory Tests and Treatment
Laboratory tests including complete blood count, erythrocyte sedimentation rate, and C-reactive protein may be considered if infection or inflammatory conditions are suspected. Common diagnoses in young runners include adductor strain, iliopsoas strain, stress fractures, athletic pubalgia (sports hernia), and femoroacetabular impingement. Treatment depends on the specific diagnosis but often includes relative rest, ice, anti-inflammatory medications, and a progressive rehabilitation program. Physical therapy focusing on core strengthening, hip stabilization, and gradual return to running is typically recommended, with the patient advised to avoid running until pain-free with daily activities and to return to running gradually, increasing distance by no more than 10% weekly.
Key Considerations
It is crucial to note that diagnosis of the primary cause of hip-related pain should never be made using imaging alone, but rather in combination with the patient’s symptoms and clinical signs 1. The diagnostic criteria should include appropriate diagnostic imaging, as well as consideration of symptoms and clinical signs.
From the Research
Initial Evaluation
The workup for a 23-year-old runner with right groin pain involves a comprehensive approach to determine the underlying cause of the pain. This includes:
- A focused history to rule out systemic symptoms and clarify the pain pattern 2
- A physical exam to identify potential causes of groin pain, such as stress fracture, Legg-Calvé-Perthes disease, slipped capital femoral epiphysis, acetabular labral tears, iliopectineal bursitis, avulsion fracture, osteitis pubis, strain of the thigh muscles or rectus abdominis, inguinal hernia, ilioinguinal neuralgia, and sports hernia 2
Potential Causes
The potential causes of groin pain in athletes include:
- Adductor strain
- Osteitis pubis
- Sports hernia
- Nerve pain
- Stress fractures
- Intrinsic hip pathology 3, 4
- Avulsion fractures of the apophyses
- Femoral neck stress fractures
Diagnostic Approach
The diagnostic approach may involve:
- Imaging studies, such as MRI, to characterize groin injuries and predict response to therapeutic injection 5
- Special tests, such as the adductor squeeze test, to predict and prevent groin injuries 6
- Judicious use of special tests and good teamwork to obtain a correct diagnosis 4
Treatment Options
Treatment options may include:
- Conservative management, such as active rehabilitation and multimodal therapy, which has been shown to be effective in reducing pain and improving function 6
- Fluoroscopy-guided corticosteroid symphyseal injection, which has been shown to be a safe and effective treatment for sports-related groin pain 5
- Surgical reinforcement of the inguinal wall in cases of true sports hernia 4
- Neurolysis to relieve nerve compression 4
- Graduated stretching and strengthening programs for adductor strains 4