ACUTE HIP AND GROIN PAIN

ACUTE HIP AND GROIN PAIN

Acute hip and groin pain occurs frequently in sports Involving twisting and turning and kicking such as the various football codes, especially soccer and Australian football. 

Symptoms can arise from various structures including the adductor muscles and tendons, the hip joint and associated muscles and bursae.

Clinical approach

In patients with acute hip and groin pain it is vital to localize the area of abnormality to make an anatomical diagnosis .

 The most common causes of acute hip/groin pain are strains of the adductor or, less com only, the iliopsoas muscles, or injuries to the hip joint itself, 

such as a labral tear and/or chondral injury.

The clinician must not overlook the less common but important causes of pain in this region, such as an intra-abdominal abnormality  \ urinary tract abnormality, gynecological abnormal ity and rheumatological disorders (e.g. ankylosing spondylitis).

 Infections such as osteomyelitis should also be considered. A list of causes of pain in this region is

Examination

Bath region of the hip and groin that has the potential lo produce pain must be examined. This includes the adductor muscles, the hip flexors and the hip joint.

1.Observation

(a)standing 

(b) walking 

(c) supine

2. Active movements 

(a) hip flexion/extension 

(b) hip abduction/adduction le hip internal/external rotation

 (d) circumduction test

Causes of acute hip and groin pain ---------------------

.Common

Adductor  Muscle strain

ADDUCTOR MUSCLE STRAIN

 Tendinopathy 

Hip Joint

 Synovitis

 Liberal tear

Chondral lesion

....Less common

Trochanteric bursitis -

Stress fracture-

iliopsoas strain-

Neck of femur-

Acetabulum -

Referred pain- 

Lumbar spine -

Sacroiliac joint-

Osteomyelitis -

Snapping' hip -

Rectus femoris muscle strain (upper third) Avulsion apophysitis/fracture -

 Anterior superior iliac spine  -

Anterior inferior iliac spine adolescents -

...Not to be missed

Slipped capital femoral epiphysis 

Intra-abdominal abnormality

 Appendicitis

Prostatitis

Urinary tract infection

 Gynecological conditions

3. Passive movements

(a) adductor muscle stretch 

(b)hip quadrant-flexion, adduction internal rotation  

(c) internal rotation, then with added adduction 

(d) flexion, abduction and external rotation

      (FABER or Patrick's test) 

(e) quadriceps muscle stretch 

(f) psoas muscle stretch/impingement (Thomas position)

4. Resisted movements

(a) hip flexion 

(b) hip adduction

5. Palpation

 (a) adductor muscles/tendons 

(b) iliopsoas

6. Functional movements

 (a) hopping (to reproduce pain)

7. Special tests

(a) standing Trendelenburg test