Long-standing groin pain in sportspeople falls into three primary patterns, a “clinical entity” approach: a prospective study of 207 patients

Abstract

Background: Groin pain remains a major challenge in sports medicine. Aim: To examine 207 consecutive athletes (196 men, 11 women) with groin pain using a standardised and reliable clinical examination programme that focused on signs that suggest pathology in (1) the adductors, (2) the ilopsoas and (3) the rectus abdominis. Patients and methods: Most patients were football players (66%) and runners (18%). In this cohort, the clinical pattern consistent with adductor-related dysfunction, was the primary clinical entity in 58% of the patients and in 69% of the football players. Iliopsoas-related dysfunction was the primary clinical entity in 36% of the patients. Rectus abdominis-related dysfunction was found in 20 (10%) patients but it was associated with adductor-related pain in 18 of these patients. Multiple clinical entities were found in 69 (33%) patients; of these, 16 patients had three clinical entities. Conclusions: These descriptive data extend previous findings that physical examination for groin pain can be reliable. While underscoring the prevalence of adductor-related physical examination abnormality in football players, the data highlight the prevalence of examination findings localising to the iliopsoas among this cohort. Also, the fact that combinations of clinical entities were present has important implications for treatment. The finding of multiple abnormal clinical entities also raises the possibility that earlier presentation may be prudent; it is tempting to speculate that one clinical entity likely precedes other developing entities. These data argue for the need for a trial where clinical entities are correlated with systematic investigation including MRI and ultrasonography.

Proposed Algorithm for the Management of Athletes With Athletic Pubalgia (Sports Hernia): A Case Series

“…Surgical exploration of patients with athletic pubalgia indicates that a small percentage of patients have a small direct or indirect hernia in combination with a sports hernia. 23,39,43,52,80 Adductor involvement is common in patients with athletic pubalgia, 4,20,21,37,71 and 3 of the 6 patients in this case series presented with a physician diagnosis and/or imaging confirmation of an adductor strain. The finding that adductor pain often improves after sports hernia repair suggests that adductor tendonitis may be a secondary phenomenon to the initial injury.…”

“…40,52,59,75 The higher reported incidence of this condition in males versus females 4,37,46,52,61 may be explained by a greater level of participation in highly competitive sports and/or gender differences in pelvic anatomy. 58 Further evaluation of female athletes often reveals a gynecological source to their symptoms, including endometriosis and ovarian cysts.…”

“…5,28,37,52,53,62 Although the investigators believed these conditions were not the primary source of the athletes' exertional pain, they might have coexisted and/or contributed to the etiology and progressed accordingly. Because evidence suggests poor surgical outcomes in nonathletes, 59 rehabilitation is currently advocated as the only course of action with these patients.…”

“…1,40,61 The differential diagnosis of groin pain is challenging, based on the significant symptom overlap among various groin pathologies and the fact that multiple dysfunctions often coexist. 5,37,62,66,80 A recent published case report outlines the differential diagnosis of a sports hernia. 79 Many diagnoses (snapping hip syndrome, hip subluxation/dislocation, acetabular labral tears, and bursitis) were immediately ruled out due to the absence of various signs and symptoms.…”

“…37,61,76 Groin pain is particularly common in sports that require athletes to perform repetitive kicking, twisting, or turning at high speeds, such as soccer, football, basketball, track and field, tennis, and hockey. 37,58,75 Despite its prevalence, the literature is filled with puzzling and often contradictory information regarding the etiology, presentation, diagnosis, and treatment of groin pain in athletes. 75 A case series of 6 athletes with a suspected sports hernia.…”