Groin pain in athletes: a novel diagnostic approach

Abstract

Groin pain in a performing athlete can be very challenging to diagnose and treat. The differential diagnosis includes intra-articular causes, extra-articular causes and non-musculoskeletal causes. A detailed clinical and radiological assessment of groin pain in this group is critical and can identify the underlying pathology. Diagnostic hip block is a valuable tool to differentiate intra-articular causes from extra-articular causes. Hip arthroscopy can help in identifying some of the elusive intra-articular conditions, which were once undiagnosed and therefore, left untreated, resulting in premature ending of competitive careers. This article attempts to explore current thinking on evaluation of groin pain, particularly in young individuals, and to establish a simple protocol for a clinical and diagnostic approach to this difficult problem.

Keywords: Athletes; Diagnosis; Femoroacetabular impingement; Groin pain; Hip arthroscopy.

Figure 1.

X-ray of right hip showing avulsion fracture of anterior inferior iliac spine in a young footballer.

Figure 2.

X-ray of the pelvis with both hips showing “pistol-grip” deformity of the proximal femur of both hips indicating “cam” type of impingement.

Figure 3.

MRI arthrogram of left hip indicating acetabular labral tear.

Figure 4.

Arthroscopic view of the hip joint demonstrating ligamentum teres injury. FH = Femoral Head; LT = Ligamentum Teres; CF = Cotyloid Fossa. ©Richard Villar.

Figure 5.

Arthroscopic view of the hip joint demonstrating severe chondral damage of the femoral head in a young man.

Figure 6.

Our novel clinical approach to athletes with groin pain.