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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can all be visualized on MRI as well [ 29 ]. Plain films and bone scans
may also be helpful in the detection of hip joint pathology such as regular
or stress fractures and osteonecrosis.
There are no widely accepted imaging algorithms for the evaluation
of groin pain; studies should be ordered as needed on a case-by-case
basis. In my institution, herniography is not routinely performed, and
thus I utilize ultrasound when needed to diagnose an occult hernia. For
patients in whom the history and physical exam is more consistent with
an alternative source of groin pain, MRI is my diagnostic test of choice.
As expertise varies between institutions, it is prudent to discuss with
radiologists which diagnostic test is most high yield in one’s hospital or
practice setting.
Documentation
Documentation of the history and physical exam should be extremely
thorough, both for accuracy and for medicolegal purposes. Whether dictating,
utilizing an electronic medical record, or handwriting notes, all of
the above aspects of the patient’s history should be incorporated into the
medical record. Many electronic medical records allow for the creation
of templates that may make it easier for practitioners to incorporate all of
the pertinent aspects of the patient’s history into the patient’s visit as well
as its documentation. When utilizing templates or copied notes, great care
must be taken to amend all documentation as appropriate, as there is a
high prevalence of errors, which may affect patient care and expose both
the patient and the physician to unnecessary risk [ 30 ].
Summary
The treatment of most causes of primary and secondary groin pain
will be thoroughly discussed throughout the remainder of this manual.
However, the initial step to all evaluations still remains obtaining and
documenting a thorough history and physical examination. When combined
with appropriate imaging studies, these key initial steps can help
to identify the cause of groin pain for the overwhelming majority of
patients.
Disclosures Dr. Greenberg is a paid consultant for Covidien and Bard-Davol.