Groin Pain Etiology: Hip-Referred Groin Pain

The orthopedic causes of groin pain are numerous and varied, and given the overlap with other medical specialties, it is often a diagnostic challenge. A clear organizational framework is necessary to determine the source as well as the pathological process responsible for groin pain. Pain may be related either to the bone or to the soft tissue surrounding it. These processes can be further divided into physiological or architectural problems in order to provide a diagnostic framework for its evaluation. This chapter discusses the relevant anatomy for this diagnostic workup and provides an outline describing the most common orthopedic causes of groin pain. More unusual conditions such as femoral acetabular impingement, labral tears, stress fractures, avascular necrosis, and transient osteoporosis are also covered. Groin-related symptoms are covered in the light of a possible orthopedic etiology. The physical examination is reviewed in detail in order to further differentiate these pathologies clinically. Recommendations for imaging and laboratory workup are explained in a stepwise and cost-effective fashion. This chapter will cover the treatment algorithms for these conditions and provide guidelines for appropriate referrals. The list, although not comprehensive, represents an excellent starting point for the orthopedic evaluation of groin pain.