How does round ligament pain typically present?

Round Ligament Pain Presentation

Round ligament pain typically presents as a sharp, stabbing pain in the lower abdomen or groin that may worsen with movement, particularly during pregnancy. While there is limited specific guideline evidence on round ligament pain presentation, we can draw from related clinical evidence to characterize this condition.

Clinical Presentation

• Round ligament pain most commonly presents as a unilateral or bilateral sharp, stabbing pain in the groin or lower abdomen that is often triggered by movement, position changes, or physical activity 1
• Pain may be described as "sharp" or "stabbing" in quality, similar to the description of tendinopathy pain 1
• The pain is typically localized to the inguinal region where the round ligament traverses, and may radiate to the labia in women 2, 3
• Symptoms are often exacerbated by sudden movements, coughing, sneezing, or changing positions 1
• In some cases, a palpable groin mass or swelling may be present, especially when associated with round ligament varicosities 2, 3

Timing and Duration

• Pain episodes are usually brief but can be intense 1
• Pain may be intermittent and self-limiting, typically subsiding with rest 1
• Symptoms commonly worsen as pregnancy progresses due to increased uterine size and ligament stretching 2, 3
• Pain may be present during activity but can subside after a period of rest, similar to patterns seen in musculoskeletal conditions 1

Special Considerations in Pregnancy

• Round ligament pain is almost exclusively seen in pregnant women, particularly in the second and third trimesters 2, 4
• In pregnant women, round ligament varicosities may present as a painful or painless inguinal mass that can mimic an inguinal hernia 3, 5
• Symptoms may be exacerbated by the Valsalva maneuver in pregnant women with round ligament varicosities 3
• Round ligament varicosities typically resolve spontaneously postpartum 5

Physical Examination Findings

• Palpation may elicit well-localized tenderness in the inguinal region 1
• Physical examination may reveal a reducible or non-reducible groin mass in cases of round ligament varicosities 2, 6
• The pain can often be reproduced with specific movements or maneuvers that stretch the round ligament 1
• In cases of round ligament varicosities, the mass may become more prominent with Valsalva maneuver 3

Differential Diagnosis

• Round ligament pain must be differentiated from other causes of lower abdominal or groin pain, including appendicitis, inguinal hernia, adnexal torsion, and urinary tract conditions 1
• Unlike appendicitis, round ligament pain is not typically associated with fever, leukocytosis, or progressive worsening 1
• Round ligament varicosities can be misdiagnosed as inguinal hernias, potentially leading to unnecessary surgical intervention 2, 6
• Ultrasound is the diagnostic imaging procedure of choice to differentiate round ligament varicosities from inguinal hernias 3, 5

Management Considerations

• Conservative management with relative rest and reduced activity is typically effective for round ligament pain 1
• Brief application of cold therapy may provide acute relief of pain 1
• Short-term use of NSAIDs may be considered for pain relief in non-pregnant patients 1
• In cases of round ligament varicosities, conservative management is successful in over 90% of patients 2