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groin_pain

groin pain

introduction

  • there are a multitude of causes of groin pain
  • the ED clinician needs to systematically exclude the more serious causes such as abdominal aortic aneurysm (AAA), strangulated groin herniae +/- bowel obstruction, and acute scrotal pain or swelling such as torsion testes
  • the patient with a past history of renal colic who presents with flank pain radiating to the groin is most likely to have renal colic again
  • the elderly patient with no obvious groin or hip pathology should have a abdominal aortic aneurysm (AAA) excluded with US or CT scan.
  • finally, don't forget to check the legs for major arterial or venous thrombosis

aetiology

  • local abscess
  • referred pain from the abdomen:
  • groin injuries:
    • impact injuries
      • fracture pelvis
      • exacerbate pre-existing inguinal herniae
      • bladder, testicular or urethral straddle injuries
      • hip pointer
        • a contusion to the iliac crest, the surrounding soft-tissue structures, or the greater trochanter of the femur
    • hip hyperextension injury
      • strain or avulsion of the sartorius muscle from the ASIS
    • groin strain
      • generally involve either the iliopsoas muscle, the adductor group, or the gracilis muscle
      • pain usually radiates down medial aspect of thigh
      • may result from falling, running, quickly changing directions, as well as kicking or doing the splits (and may be strained during coitus with excessive abduction)
    • osteitis pubis / gracilis syndrome
      • a chronic injury that causes resorption of the bone or cartilage of the pubic symphysis due to repetitive stress from kicking, lifting, running, or jumping
    • rectus abdominis strain
      • fairly common in skaters, hockey players, and swimmers (especially breaststrokers)
    • sportsman's “hernia” / Gilmore groin
      • characterized by chronic groin pain that is associated with a dilated superficial inguinal ring
      • controversial syndrome, the definition, therefore, is any condition that causes persistent unilateral pain in the groin without a demonstrable hernia
      • pain is located near the pubic tubercle, maximal on the evening of vigorous exercise or on the morning afterward, and exacerbated by activities that increase the intra-abdominal pressure
    • stress fractures
      • femoral neck or pubic rami
    • avulsion fractures
      • generally occur in adolescents and young adults
      • history of severe, sudden-onset, and well-localized pain
    • femoroacetabular impingement
      • thought to result from abnormal contact stress and joint damage around the hip, most notably from prolonged sitting, leaning forward, getting in and out of a vehicle, or performing a pivoting motion in sports
groin_pain.txt · Last modified: 2013/05/31 23:49 (external edit)