Differential Diagnosis for Hip and Groin Pain
The following differential diagnosis is organized into categories to help guide the thought process:
- Single most likely diagnosis:
- Hip flexor strain/iliopsoas tear: This is a common injury, especially in athletes who participate in sports that involve sprinting, kicking, or jumping. The iliopsoas muscle is prone to strain and tear due to its anatomy and function.
- Other Likely diagnoses:
- Iliopsoas bursitis and tendinitis: Inflammation of the iliopsoas bursa or tendinitis of the iliopsoas tendon can cause hip and groin pain, especially with activities that involve hip flexion.
- Internal snapping pelvis: Also known as coxa saltans, this condition occurs when the iliopsoas tendon snaps over the iliopectineal eminence, causing a snapping sensation and pain.
- Adductor strain: Strain of the adductor muscles can cause groin pain, especially with activities that involve adduction of the hip.
- Do Not Miss diagnoses:
- Hip fracture or osteonecrosis: Although less common, hip fracture or osteonecrosis can present with hip and groin pain, and missing these diagnoses can have serious consequences.
- Inguinal hernia: An inguinal hernia can cause groin pain and should not be missed, as it may require surgical intervention.
- Ovarian torsion or testicular torsion: These are medical emergencies that can present with severe groin pain and should not be missed.
- Rare diagnoses:
- Piriformis syndrome: Although rare, piriformis syndrome can cause hip and groin pain, especially with activities that involve hip rotation.
- Psoas abscess: A psoas abscess is a rare condition that can cause hip and groin pain, especially if there is an underlying infection.
- Avulsion fracture of the lesser trochanter: This is a rare injury that can occur in athletes who participate in sports that involve sudden contraction of the iliopsoas muscle.