see also:

• back pain in the ED
• flank pain
• hip pain

• 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

• groin herniae
• lymphadenopathy
• local abscess
• referred pain from the abdomen:
  • renal colic
  • endometriosis
  • abdominal aortic aneurysm (AAA)
• meralgia paresthetica
• hip pain
• herpes zoster (shingles)
• extensive DVT
• 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
    • meralgia paresthetica
  • 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