Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

8. Groin Pain Etiology: Hip- Referred Groin Pain
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Physical Exam Patients present with groin and hip pain, typically
exacerbated with any movement about the hip. Among patients with
pubic ramus fractures, palpation of the pubic symphysis is often
particularly painful. It is also important to palpate the sacrum, as
tenderness to palpation may represent a fracture of the sacral ala.
Diagnostic Exams Among those with nondiagnostic x-rays, CT scan
will help demonstrate nondisplaced and minimally displaced fractures
about the hip. However, MRI is preferred, specifically for femoral neck
fractures, as it is 100 % sensitive in the detection of radiographically
occult femoral neck fractures [ 8 ]. A black line within the bone on
T1-weighted images indicates a nondisplaced fracture.
Appropriate Treatment/Referral Nondisplaced pubic ramus and
sacral ala fractures may be treated with simple pain control and
radiographic follow-up to ensure that no unrecognized instability is
present. If x-ray examination remains stable following mobilization, the
patient does not require protected weight bearing; however, a walking
aid should be recommended to ensure stability. On the other hand,
nondisplaced femoral neck and intertrochanteric fractures require strict
non-weight bearing and immediate referral to an orthopedic surgeon, as
displacement may lead to a more difficult surgical treatment or
displacement of the fragment.
Physiological
Septic Hip
Presentation A septic joint typically presents with acute onset hip
and/or groin pain that is exacerbated by movement. Patients may or
may not demonstrate erythema and swelling, due to the extent of the
soft tissue surrounding the hip. A history of recent sexual contacts
should be obtained among those who are sexually active, as gonococcal
infections are known to present with monoarticular septic joints.
Consideration of this diagnosis should also be considered among
immunocompromised patients.
Physical Exam Patients report a painful joint, with dramatic increase in
pain with any motion. It is this sign of irritable range of motion, with
even small movements, that is the most reliable of the clinical signs.