Saturday, June 15, 2024

Groin Injury

Introduction and Frequency

Groin injuries are commonly encountered by physicians and clinicians who treat athletes of all ages at all levels of competition. Groin injuries are particularly common in activities in which forceful adduction of the hip occurs; examples include skating, ice hockey, swimming, and soccer. In fact, as many as 10% of ice hockey–related injuries and 5% of soccer-related injuries are groin injuries.
This article focuses on acute and chronic groin injuries related to sporting activities. Groin injuries resulting from major trauma (eg, multiple trauma, penetrating injuries) are not addressed, except to note that they require emergent medical evaluation.

The images shown below illustrate the relevant anatomy of the pelvis relating to groin injuries.

Pelvis, symphyseal aspect.

Pelvis, symphyseal aspect.

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Pelvis, frontal view.

Pelvis, frontal view.

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Pelvis, lateral aspect.

Pelvis, lateral aspect.

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Give special consideration to children, adolescents, and females with groin pain, because these conditions in this patient population may be erroneously attributed to minor trauma when they are, in fact, serious and require medical or surgical intervention. Evaluate any child aged 2-15 years with groin pain and an antalgic gait, especially if he or she has a fever. Avascular necrosis (AVN) of the hip, Legg-Calve-Perthes disease, septic arthritis, and slipped capital femoral epiphysis must be ruled out.
Consider early orthopedic consultation in any such case.

Hip pain in the adolescent athlete must take into consideration the relatively weaker growth plate of certain bony structures in the hip, and it should prompt the clinician to consider the diagnosis of apophyseal avulsion fractures. Apophysitis and apophyseal fractures are more common in skeletally immature athletes, in whom the physis is the weakest link in the muscle – tendon – bone complex.
Moreover, remember that children and adolescents may report knee pain that is actually referred from pathology in the hip, or vice versa. That is, complaints of both hip and lower-extremity pain in children and adolescents merit a detailed physical examination of the affected joint and surrounding structures.

The initial evaluation and conservative treatment for adult female athletes may be similar to that of male athletes. However, epidemiologic findings suggest that differences in female body mechanics may lead to subtly different injury patterns and a need for specialized rehabilitation services.
Although anatomic differences are obvious, several factors play important roles in determining injury patterns in female athletes. These factors include (1) differences in metabolism, circulation, and cardiorespiratory capacity; and (2) differences in body shape, size, and composition. An example of such is the higher rate of patellofemoral disorders in female athletes, possibly accounted for by an increased quadriceps angle, less developed vastus medialis, and greater degree of genu valgum.

For patient education resources, see the Sports Injury Center, as well as Muscle Strain and Hernia.

Go to Female Athlete Triad, Low Energy Availability in the Female Athlete, and Osteitis Pubis for complete information on these topics.

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