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
Fig. 4.1. In The “C Sign,” the hand is cupped over the hip in the shape of the
letter C with the ipsilateral index finger positioned over the groin and the thumb
located proximal to the greater trochanter.
the thumb located proximal to the greater trochanter [ 10 ]. Patients with
adductor injuries often complain of a pulling or tearing sensation in the
groin with activity, while those with osteitis pubis note tenderness over
the pubic symphysis. Patients with sports hernias typically complain of
pain that is unilateral and burning or sharp in nature. The pain may radiate
to a variety of locations, including the proximal thigh, lower back,
lower abdomen, and downward to the scrotum as well [ 11 ]. Patients are
generally able to sleep comfortably through the night, but upon awakening
may experience extreme pain while attempting to get out of bed.
Sudden movements, especially rotational or forceful activities such as
sit-ups, cutting, and rapid acceleration or deceleration, will exacerbate
these symptoms [ 5 ], while periods of rest will often relieve them, only to
have them return upon resuming athletic activities [ 12 ].
Patients with inguinal hernias as their source of groin pain may experience
a different set of symptomatology from those with sports hernias.
The pain or discomfort associated with the inguinal hernia tends to be
progressive over the course of the day and will be worse even in the
evenings. Certain positions that increase intra-abdominal pressure, such
as sitting, may exacerbate these symptoms, while lying supine may
relieve them and return the hernia contents to their intra- abdominal location.
Many patients will note increases in pain with forceful activities
such as sneezing, coughing, and bowel movements, and some will