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
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located at the confluence of the origin of the rectus abdominis muscle,
the adductor longus tendon on the pubic bone, and the insertion of the
inguinal ligament on the pubic bone [ 8 ]. Pain onset is typically insidious,
exacerbated by activity and improved with rest. Various surgical
techniques have been reported, ranging from standard inguinal hernia
repair with or without mesh, to incorporation of rectus reattachment in
combination with adductor release in select cases. A commonly found
area of pathology reported in the literature is the posterior inguinal wall
along the transversalis fascia [ 9 ].
Referred Groin Pain from Lumbar Disc Herniation
Referred groin pain in the absence of low back or radicular pain is
found in a small subset of patients with singular lumbar disc herniation.
A retrospective study of 512 subjects diagnosed with singular lower
lumbar disc herniation (L4-L5 and L5-S1) at Kakegawa City General
Hospital between July 1990 and December 1993 reported a 4.1 % incidence
of groin pain, especially in the subset of patients with L4-5
involvement [ 10 ]. A subsequent prospective study in 2010 found evidence
supporting degenerated intervertebral disc as an etiology for
referred groin pain: ten subjects with groin pain and single disc degeneration
found on MR underwent evaluation of changes in pain scale after
local hip joint block, pain provocation on discography, and anesthetic
discoblock. All ten subjects had a negative hip joint block, while five
showed pain on discography and improvement in pain with discoblock,
and definitive improvement after surgical fusion [ 11 ]. The proposed
mechanism based on physiology studies in rats is the existence of overlapping
segments of dorsal root innervation for the sensory nerve endings
in the lower lumbar discs, with some of the sensory nerves from the
L5 intervertebral disc coming from upper dorsal root ganglions of L2,
which supply the genitofemoral and ilioinguinal nerves [ 12 ]. Thus, it is
possible for patients to feel referred groin pain corresponding to the L2
dermatome.
Spermatic Cord and Testicular Causes
The urologic etiologies for groin pain are quite extensive, including
but not limited to epididymitis, hematocele, hydrocele, varicocele,
malignancy, orchitis, Fournier’s disease, and testicular torsion.