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

4. Chief Complaint of Groin Pain…
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reflexively hold their groin during these activities in order to mitigate
these symptoms. Unlike patients with sports hernias, those with inguinal
or femoral hernias will often notice a bulge and may associate their
symptoms with a change in its size. All patients should be asked about
any change in bowel or bladder habits to assess for any obstructive type
symptoms and should also be asked about any history of incarceration
of their hernias.
While traditional hernias, sports hernias , and other sport- related musculoskeletal
injuries comprise the majority of causes for groin pain,
there are many other congenital and acquired causes of groin pain that
should be factored into one’s differential diagnosis. Congenital disorders
associated with osteonecrosis of the hip, including slipped capital femoral
epiphysis, congenital hip dysplasia, and Legg–Calvé–Perthes disease
, may all be a source of groin or hip pain in adulthood [ 13 ]. Other
causes of osteonecrosis such as chronic steroid use or alcohol abuse
should also be assessed. Many genitourinary conditions may present
with groin pain as well, and these should be discussed in detail, especially
with sexually active women and women of childbearing age
where the differential diagnosis should include conditions such as pelvic
inflammatory disease, ectopic pregnancy, ovarian cysts, endometriosis,
ovarian torsion, and round ligament pain.
An accurate and thorough history is the key initial step in the workup
of all patients with groin pain. While the history alone may not confirm
the diagnosis, it will help determine which physical exam maneuvers
and ancillary studies will be most appropriate and helpful in determining
the cause of the patients’ complaints.
Physical Exam
The physical examination should begin with vital signs, including
accurate height and weight . Overweight and obese patients have a lower
incidence of inguinal hernia formation compared to normal weight individuals
[ 14 , 15 ]. Routine physical examination of the thorax and abdomen
should be performed, but the majority of the physical exam should
be focused on the groin and the hip. The back, pelvis, groin, and upper
thigh should be completely exposed in order to facilitate a thorough
examination.
Examination should begin in the upright position with inspection.
Palpation of the spine and paraspinal muscles should be done. Unilateral
inguinal hernias will often be apparent as an asymmetric bulge in the