What are the possible causes of a quivering sensation and pain in the left groin area?

Differential Diagnosis of Left Groin Pain with Quivering Sensation

The most likely causes of quivering sensation and pain in the left groin are iliopsoas tendinitis/bursitis, inguinal hernia, or athletic pubalgia (sports hernia), with the quivering sensation suggesting either muscle fasciculations from overuse or nerve irritation. 1, 2

Primary Diagnostic Considerations

Musculotendinous Pathology (Most Common)

• Iliopsoas tendinitis/bursitis presents with anterior groin pain and can cause a sensation of snapping or abnormal movement that patients may describe as "quivering" 1, 3
• The American College of Radiology identifies iliopsoas pathology as a primary consideration for anterior groin pain, often coexisting with snapping hip syndrome 1
• Adductor muscle strain or enthesitis causes groin pain that worsens with activity and may produce abnormal sensations from muscle spasm 4

Hernia-Related Causes

• Inguinal hernia commonly presents with groin pain, burning, gurgling sensations, and a heavy or dragging feeling that worsens with activity 2
• Athletic pubalgia ("sports hernia") from abdominal wall weakness frequently mimics intra-articular hip pathology and can cause groin pain with abnormal sensations 3, 5

Nerve-Related Pathology

• Ilioinguinal neuralgia can produce burning, tingling, or quivering sensations along with pain in the groin region 5

Recommended Diagnostic Algorithm

Step 1: Initial Clinical Assessment

• Perform the adductor squeeze test: patient supine with hips abducted and flexed at 80 degrees; positive if sharp pain occurs when attempting to adduct against resistance 4
• Perform the flexion-adduction-internal rotation test to rule out intra-articular hip pathology; a negative test helps exclude labral tears 1
• Examine for palpable bulge or impulse while patient coughs or strains to detect inguinal hernia 2

Step 2: First-Line Imaging

• Obtain plain radiographs of the pelvis/hip first to exclude osseous pathology, arthritis, or structural abnormalities—this is the recommended first-line imaging for all chronic hip pain presentations 1

Step 3: Advanced Imaging if Radiographs Negative

• Ultrasound is the preferred next step for suspected iliopsoas pathology or hernia, as it can evaluate the iliopsoas tendon dynamically, guide therapeutic injections, and detect hernias during Valsalva maneuver 1, 6, 2
• MRI is highly sensitive and specific for detecting iliopsoas bursitis, tendinitis, and associated intra-articular pathology if ultrasound is inconclusive 1

Step 4: Diagnostic Injection if Diagnosis Remains Unclear

• Ultrasound-guided diagnostic injection into the iliopsoas bursa can differentiate between iliopsoas pathology and intra-articular hip joint pain when the source remains unclear 1, 3

Initial Management Approach

Conservative Treatment (First 4-6 Weeks)

• Activity modification with avoidance of aggravating movements 1
• Physical therapy focusing on iliopsoas stretching, strengthening of hip stabilizers, adductor muscles, abdominal wall muscles, and hamstrings 1, 4
• NSAIDs for pain control and anti-inflammatory effect 1, 4
• Muscle relaxants may be beneficial for muscle-related pain 4

If Symptoms Persist After 4-6 Weeks

• Proceed with ultrasound-guided corticosteroid injection into the iliopsoas bursa or peritendinous region, which provides both diagnostic confirmation and therapeutic benefit 1

Surgical Referral Indications

• Failure of conservative treatment and injection therapy after appropriate trial 4
• Confirmed inguinal hernia causing significant symptoms (refer to original surgeon if recurrent) 2

Critical Pitfalls to Avoid

• Do not miss referred pain from the lumbar spine—examine the spine and consider spine imaging if the hip examination findings are inconsistent with the pain pattern 1
• Do not rely on physical examination alone for hernia diagnosis when symptoms are present but no bulge is palpable—ultrasonography is indicated in athletes without palpable findings 2
• Do not assume a single cause—groin pain is frequently multifactorial, and symptoms may arise from overlapping pathologies including gynecologic, gastrointestinal, or core muscle injuries 3, 6
• Do not overlook serious pathology such as stress fractures, avulsion fractures, or vascular causes that require different management 5