Groin Pain and Injuries: Evaluation and Management

Groin pain is a common symptom in athletes and the general population. Etiologies include musculoskeletal conditions involving the pubic rami, hip joints, pelvic floor, and abdominal wall, as well as hernias and genitourinary conditions. Differentiating musculoskeletal from nonmusculoskeletal symptoms and identifying a specific cause can be a diagnostic challenge. A systematic approach to physical examination can focus the differential diagnosis and guide additional evaluation and specific management. Physical examination should include direct palpation and testing for the major musculoskeletal causes of groin pain: adductor, pubic, inguinal, and iliopsoas. In patients with adductor-related groin pain, magnetic resonance imaging of the pelvis should be performed if the diagnosis is unclear or if symptoms have not improved after initial conservative management. Active, supervised physical therapy is the initial treatment recommended for adductor- and pubic-related groin pain. In patients with inguinal-related groin pain, dynamic ultrasonography should be performed to rule out a true hernia and evaluate for posterior abdominal wall weakness. Initial management for patients with inguinal-related groin pain without evidence of a hernia is physical therapy focusing on core strengthening and neuromuscular rehabilitation. Hip radiography and magnetic resonance imaging are preferred in patients with suspected iliopsoas-related groin pain because there is often concomitant hip pathology.