inguinal pain

Introduction

pain in the inguinal region

Etiology

• inguinal hernia
• musccle & tendon injuries
  • adductor tendon strain
  • iliopsoas strain or tendonitis
  • iliopsoas bursitis
• nerve entrapment
• osteitis pubis
• sacroiliitis
• stress fracture of femoral neck (hip fracture) or pubic ramus
• hip joint arthralgia
• urogenital
  • urinary tract infection
  • prostatitis
  • urinary calculus
  • epidydimitis
  • testicular pain
• lumbar disc disease
• referred pain: abdominal pain or pelvic pain
  • inflammatory bowel disease
  • diverticulitis
• prior inguinal surgery

Epidemiology

• 2% to 20% to athletes

Clinical manifestations

groin pain syndrome

• variation in frequency, duration,7 intensity of symptoms
  • some with constant pain & others with pain only during or after activity
• tenderness over the external inguinal ring, the pubic tubercle, or the insertion of the adductor longus tendon or lower rectus muscle on the pubic bone
• hip pain common

Radiology

• magnetic resonance imaging
  • indicated when groin pain cannot be distinguished from hip joint pathology
  • subcortical pubic bone or marrow edema
  • rectus-adductor plate & enthesial inflammation.
    • tears or strains in the rectus or adductor muscle-tendon complex
    • osteitis pubis
    • pubic symphyseal edema
• dynamic ultrasonography
  • ultrasonography of the inguinal canal with Valsalva may show protuberance in the direct space of the inguinal canal

Complications

• hip joint pathology commonly occurs with groin pain syndrome

Management

• rest 2-8 weeks with NSAIDs
• physical therapy:
  • core flexibility
  • strengthening & neuromuscular reeducation during activity
  • functional motions
• multidisciplinary team approach
  • surgeon with expertise in inguinal pathology & the pubic joint
  • orthopedic surgeon with expertise in hip pathology
  • physical therapist with proficiency in hip pathology