What could be causing a pinching sensation in my right groin when I bend forward, and how should I manage it?

Pinching Sensation in Right Groin When Bending Forward

The most likely cause of a pinching sensation in your right groin when bending forward is femoroacetabular impingement (FAI) syndrome or an acetabular labral tear, both of which produce sharp, catching groin pain with hip flexion movements. 1, 2

Immediate Assessment Required

Before pursuing musculoskeletal causes, you must exclude serious pathology through targeted questions:

• Night pain, fever, inability to bear weight, or constitutional symptoms suggest stress fracture, tumor, infection, or (in younger patients) slipped capital femoral epiphysis—all requiring urgent evaluation. 1
• Progressive neurologic symptoms (numbness, weakness radiating down the leg) indicate possible lumbar spine pathology requiring urgent referral. 3

Most Likely Diagnoses for Pinching Groin Pain with Bending

Intra-articular Hip Pathology (Primary Suspects)

Femoroacetabular Impingement (FAI) Syndrome is the leading cause of groin pain in young to middle-aged active adults, characterized by:

• Sharp, pinching groin pain with hip flexion, adduction, and internal rotation (exactly what happens when bending forward). 1, 2
• Pain may radiate to the back, buttock, or thigh. 2
• Mechanical symptoms like catching or locking. 1
• A positive FADIR test (flexion-adduction-internal rotation) strongly supports this diagnosis. 1, 2

Acetabular Labral Tears frequently coexist with FAI and present with:

• Sharp, catching pain in the groin with mechanical symptoms. 1
• These tears are found in 59% of hip arthroscopies and are most commonly located in the anterior acetabulum. 4
• Labral pathology almost always occurs alongside FAI or dysplasia, not in isolation. 1, 2

Extra-articular Causes

Iliopsoas Tendinopathy produces:

• Anterior/medial groin pain with hip flexion against resistance—relevant when bending involves lifting or reaching. 1
• This can be evaluated with ultrasound and responds to targeted injection. 4, 3

Adductor-Related Pain presents with:

• Medial groin discomfort and tenderness over adductor tendons. 1
• Pain with resisted adduction, though this is less likely to cause pinching specifically with forward bending. 1

Critical Diagnostic Step: Exclude Lumbar Spine Referral

Lumbar spine pathology (L1-L3 radiculopathy) must be screened in every patient with groin pain because nerve root irritation can mimic hip pathology and present as groin/medial thigh pain. 1, 3, 2 This is a common pitfall—hip and spine pathology frequently coexist or are confused.

Recommended Diagnostic Algorithm

Step 1: Physical Examination

• Perform the FADIR test: With you lying supine, the examiner flexes your hip to 90°, then adducts and internally rotates it. Sharp groin pain reproducing your symptoms indicates intra-articular hip pathology (FAI or labral tear). 1, 2
• A negative FADIR test helps rule out hip joint disease and shifts focus to extra-articular causes like adductor or iliopsoas pathology. 1, 3
• Assess hip internal rotation range of motion—limitation suggests FAI or early osteoarthritis. 2
• Screen the lumbar spine with neurologic examination and provocative maneuvers to exclude referred pain. 1, 2

Step 2: Initial Imaging

Obtain AP pelvis and lateral femoral head-neck radiographs (Dunn, frog-leg, or cross-table views) first. 1, 2

• These detect cam or pincer morphology (FAI), hip dysplasia, osteoarthritis, and exclude fractures or tumors. 1, 3
• Critical caveat: Cam morphology is present in ~14% of asymptomatic individuals (24.7% of asymptomatic men), so imaging findings must correlate with your symptoms and positive physical exam. 2

Step 3: Advanced Imaging (If Radiographs Are Negative or Inconclusive)

MRI or MR arthrography is indicated when:

• Radiographs are negative but clinical suspicion for intra-articular pathology remains high. 4, 1
• Surgical planning is being considered after failed conservative management. 2
• MRI detects labral tears, chondral damage, and ligamentum teres pathology with high sensitivity and specificity. 4, 1
• MR arthrography (intra-articular gadolinium injection) is the gold standard for labral tears, though high-resolution 3T MRI without contrast may be sufficient. 4

Ultrasound is useful for:

• Evaluating superficial structures like iliopsoas tendon or adductor tendons. 4, 3
• Guiding diagnostic/therapeutic injections. 3

Management Approach

First-Line Conservative Treatment (3-6 Months)

Begin with activity modification, physical therapy emphasizing hip muscle strengthening and movement quality, and NSAIDs. 2

• This approach improves pain, function, and quality of life in FAI syndrome. 2
• Physical therapy should include stretching and strengthening of hip flexors, adductors, abdominal wall, and core muscles. 5, 6

Diagnostic/Therapeutic Injection

If the pain source remains unclear after imaging, image-guided anesthetic and corticosteroid injection can provide both diagnostic confirmation and therapeutic benefit:

• Intra-articular hip injection determines if pain originates from the hip joint versus surrounding structures. 3
• Iliopsoas or adductor tendon injection under ultrasound guidance can be both diagnostic and therapeutic. 3

Surgical Referral Indications

Arthroscopic hip surgery is indicated only after 3-6 months of failed conservative management with persistent symptoms, positive FADIR test, and MRI-confirmed labral/chondral damage. 2

• Surgery should never be based on imaging findings alone—cam morphology without symptoms does not merit treatment. 2

Common Pitfalls to Avoid

• Do not treat imaging findings in isolation: Incidental FAI morphology and labral abnormalities are extremely common in asymptomatic individuals. 1, 2
• Do not miss referred pain: Hip pathology can present as knee pain, and spine pathology can present as hip pain. 1
• Recognize coexisting pathology: Labral tears almost always occur with FAI or dysplasia, not alone. 1, 2
• Age matters: In adolescents/young adults, consider slipped capital femoral epiphysis (SCFE), which presents as medial thigh or groin pain. 1