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

5. Groin Pain: An Overview
of the Broad Differential Diagnosis
Charles Ma and Archana Ramaswamy
Introduction
Groin pain or inguinodynia has a broad differential diagnosis.
Different processes, including but not limited to anatomic pathology,
neuromuscular, urinary conditions, trauma, and postsurgery, can cause
activation of pain fibers in the inguinal region and the subsequent sensation
of pain. It is important to separate primary inguinodynia from secondary
inguinodynia. This chapter first describes common causes of
primary inguinodynia and then briefly discusses groin pain after surgery.
Evaluation and management are addressed in detail in subsequent
chapters.
Inguinal Hernias and Femoral Hernias
The etiology of inguinal pain can be straightforward if a groin bulge
is the chief complaint and a hernia is palpated on exam. Common exacerbating
factors to note in the history include major lifting or coughing.
Pain occurring later in the day, after prolonged standing or straining, is
also consistent with a hernia.
Inguinal hernias are the most common, accounting for 70–75 % of
all hernias [ 1 ]. They are divided into indirect and direct forms, with the
indirect form being the most common. The pathophysiology behind an
indirect hernia is a patent processus vaginalis that failed to degenerate
after descent of testes during fetal development. This potential space
allows intra-abdominal contents to pass from the deep inguinal ring to
the superficial inguinal ring. Direct hernias are protrusions within
Hasselbach’s triangle, directly through a weakened posterior wall of the
© Springer International Publishing Switzerland 2016
B.P. Jacob et al. (eds.), The SAGES Manual of Groin Pain,
DOI 10.1007/978-3-319-21587-7_5
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