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inguinal pain
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 [2]
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 [2]
- 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 [2]
- 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 [2]
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 [2]
References
- Richardson WS et al
The Treatment of Inguinal Pain
Ochsner J. Spring 2009 9(1):11-13
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096235/
- Zuckerbraun BS, Cyr AR, Mauro SC.
Groin Pain Syndrome Known as Sports HerniaA Review.
JN Learning. April 1, 2020
https://edhub.ama-assn.org/jn-learning/module/2760509
- Mayo Clinic: Groin Pain (male)
http://www.mayoclinic.org/symptoms/groin-pain/basics/causes/sym-20050652