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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tical to early AVN of the femoral head; therefore, the two processes are
difficult to differentiate. However, the changes are typically more diffuse
for transient osteoporosis as compared to the more classic “bandlike
pattern” of femoral head involvement seen in AVN [ 16 ].
Differential Early AVN and inflammatory or infectious causes should
be considered.
Appropriate Treatment/Referral In patients with radiographically
recognizable lesions, patients should practice protected weight bearing
for 4–6 weeks and be supplemented with vitamin D and calcium. Although
relatively rare, fracture of the demineralized femoral head and neck is
reported, and the patient should be aware of such a complication. If pain
is uncontrollable with mild analgesics, consideration may be given to
bisphosphonate therapy and/or core decompression via an operation. That
said, there is poor evidence to strongly recommend either option. Small
case series report early resolution of clinical symptoms with both
bisphosphonate therapy and core decompression therapy [ 17 , 18 ].
Groin Pain from the Soft Tissue
Architectural Problems
Snapping Hip Syndrome
Presentation Patients with snapping hip syndrome present with
painful popping sensations in the groin with movement. The problem is
common and is estimated to occur in 5–10 % of the general population
[ 10 ]. The differential for a snapping hip includes intra- articular and
extra-articular causes.
Intra-articular causes include labral tears, osteochondral lesions, or
loose bodies. Rarely, injuries to the ligamentum teres following dislocation
may also present with intra- articular snapping.
An external snapping hip pops or catches while in hip flexion. It is
typically related to either the iliotibial band or tensor fascia lata catching
over the greater trochanter. Alternatively, the gluteus tendon may also
catch over the trochanter. This catching leads to inflammation and pain
over the lateral greater trochanter and may present similar to bursitis.
Internal snapping hip by contrast presents with a popping or catching
sensation upon external or internal rotation. Here, it is typically the