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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Fig. 4.2. The examiner places pressure on both groins, while the patient actively sits
up. Pain indicates a possible inguinal disruption injury.
flexors (iliopsoas and rectus femoris) can also be tested at this point with
leg flexion against resistance. If all is normal, yet the patient only has
tenderness over the internal ring region of the canal without a palpable
hernia, a “sports hernia” can then be suspected.
There are a wide variety of physical exam maneuvers that can be
employed to assess for hip joint injury as the cause of groin pain (Table
4.2 ) [1 , 10 , 22 –25 ]. Range of motion, strength, and provocative maneuvers
may all be necessary; however, the majority of these clinical tests
have not been found to be of substantial quality to dictate clinical decision
making [ 26 ]. The majority of these maneuvers are outside the scope of
practice for most general surgeons, and if hip pathology is suspected, then
early referral to Sports Medicine or Orthopedic Surgery is warranted, as
radiographic studies will likely be necessary to make a firm diagnosis.
Another step in a pain physical exam will depend on the history. For
athletes, asking them to mimic the maneuver that was associated with
the onset of the symptom can help pinpoint the cause. Having the patient
mimic a basketball layup or a defensive tennis stance, for example, may
help reproduce the pain of an adductor tear.
Finally, the iliohypogastric, ilioinguinal, and genitofemoral nerve
distributions should also be examined and documented regarding the