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

8. Groin Pain Etiology: Hip- Referred Groin Pain
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Fig. 8.3. The extent of internal rotation of the hip is assessed with the hip in 90
degrees of flexion.
with a slowly progressive pain in the groin, hip, or thigh, typically worse
in the morning and at night. Patients describe an aching pain that
improves with light activity and is worse with strenuous activity. Patients
commonly report difficulties with initial motion after prolonged periods
of rest, with improvement after a few steps. More advanced hip OA
eventually results in stiffness and difficulty with activities of daily living.
Physical Exam The classic finding of crepitus with range of motion is
rare. Patients may present with a very stiff joint, often with back pain that
is more severe than the hip pain. Alternatively, some patients present with
severe pain on weight bearing, with an almost normal range of motion. An
important and early clinical sign of hip OA is decrease in internal rotation.
Passive external rotation during flexion of the hip is known as Drehmann’s
sign and is indicative of this loss of internal rotation. Eliciting a positive