What is the workup for a female long distance runner with right groin pain, exacerbated by weight-bearing and internal rotation of the right hip, and tenderness in the anterior upper thigh?

From the Guidelines

The workup for a female long distance runner with right groin pain should begin with a thorough history and physical examination, focusing on the hip and pelvis, and initial imaging should include plain radiographs of the pelvis and hip to evaluate for stress fractures, particularly of the femoral neck. Given the symptoms of pain with weight-bearing and internal rotation, along with anterior thigh tenderness, a femoral neck stress fracture or iliopsoas tendinopathy should be highly suspected 1. Magnetic resonance imaging (MRI) of the hip is essential to assess for soft tissue injuries such as labral tears, iliopsoas tendinopathy, or athletic pubalgia 1. Laboratory tests including complete blood count, erythrocyte sedimentation rate, and C-reactive protein may help rule out inflammatory conditions. Assessment of the patient's menstrual history and bone density is important to evaluate for female athlete triad (disordered eating, amenorrhea, and osteoporosis), which increases stress fracture risk 1. Some key points to consider in the workup and management include:

• Identifying and addressing contributing factors such as menstrual health, nutritional factors, biomechanical factors, mechanical loading issues, and footwear 1
• Using a multi-disciplinary approach to the return-to-running process, including the involvement of registered dietitians, physiotherapy guidance, podiatry assessment, physiological assessment by a trained sports medicine physician, and possible referral for mental health counselling where applicable 1
• Temporarily reducing or ceasing running activities and using non-weight-bearing exercises to maintain fitness while awaiting diagnosis
• Using NSAIDs like ibuprofen (400-600mg three times daily with food) to manage pain and inflammation, but with caution in endurance athletes due to potential renal effects. It's also important to note that the return to running should be gradual and individualized, with a focus on addressing the athlete's risk profile and managing the risk of reinjury 1.

From the Research

Workup for Right Groin Pain in Female Long Distance Runner

The workup for a female long distance runner with right groin pain, exacerbated by weight-bearing and internal rotation of the right hip, and tenderness in the anterior upper thigh, may involve several steps:

• Clinical evaluation: A thorough physical examination, including assessment of hip range of motion, strength, and tenderness, is essential in diagnosing the cause of groin pain 2, 3.
• Imaging studies: Radiographs, MRI, and CT scans may be used to evaluate the hip joint and surrounding structures for signs of injury or degeneration, such as femoral acetabular impingement or stress fractures 2, 4, 5.
• Differential diagnosis: Consideration of various potential causes of groin pain, including hip, pelvis, and lower extremity injuries, as well as pelvic floor disorders, is crucial in developing an effective treatment plan 6.

Potential Causes of Groin Pain

Several potential causes of groin pain in female long distance runners have been identified, including:

• Femoral acetabular impingement: A condition characterized by abnormal contact between the femoral head and acetabulum, leading to pain and limited mobility 2.
• Pubic bone stress injury: A type of overuse injury that can cause chronic groin pain and tenderness 4.
• Pelvic floor disorders: Conditions such as pelvic floor hypertonic disorder can contribute to groin pain and should be considered in the differential diagnosis 6.
• Stress fractures: Uncommon but potentially serious injuries that can occur in the pelvis, particularly in female long distance runners with risk factors such as amenorrhea and osteoporosis 5.