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

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J.A. Greenberg
inguinal hernia. In fact, most hernias present as asymptomatic, or as a
bulge without accompanying pain, and so when the patient says they
have pain in the region of the groin, the physician’s focus must shift. Do
not assume that the pain is simply because the patient has a hernia.
Groin pain is a common complaint seen in primary care clinics
throughout the world. In sports medicine clinics across the United
States, groin pain accounts for roughly 10 % of office visits [ 1 ]. While
groin pain is a common complaint among elite athletes, there are multiple
causes of groin pain, including inguinal and femoral hernias that
affect a large percentage of nonathletes as well [ 2 ]. With a wide variety
of pathologies as potential causes of hip or groin pain, it is imperative
to begin all evaluations with a thorough history and physical exam. An
accurate history and physical accompanied by appropriate ancillary
imaging studies can help to determine the specific cause of groin pain
in the majority of patients. In this chapter, we will review the pertinent
initial workup for patients presenting with groin pain.
History
As with all other medical problems, the workup for patients with
groin pain should begin with a thorough and accurate history of the present
illness. The history should start with questions about the spine and
back, then the hip, and then the abdominal wall, groin, and accompanying
upper leg. This history will guide not only the physical exam maneuvers
required for a thorough evaluation but will also lead to prompt
diagnosis and treatment through the ordering of appropriate diagnostic
tests and referrals if needed.
The pain should be characterized in terms of location, duration, sensation,
onset, severity, aggravating or alleviating factors, and pattern of
radiation. Additionally, in patients with chronic groin pain, these symptoms
may change with time, and this should be elicited as part of the
history. Patients with inguinal hernias will frequently note a bulge in the
groin, while many other pathologies, such as hip sources of groin pain,
musculoskeletal strain, and sports hernias, may not be associated with a
bulge. Patients should be asked about pain with specific movements and
activities as this may help to further narrow the differential diagnosis.
Additionally, patients should be queried about the presence or absence
of mechanical symptoms with their gait as this points to the presence of
labral tears or loose bodies of the hip as the likely diagnoses [ 3 , 4 ]. Table
4.1 shows many of the possible causes of groin pain.