Sports injuries to the hip and groin region have been noted in 5% to 9% of high school athletes [1,2]. These injuries occur most commonly in athletes participating in sports involving side-to-side cutting, quick accelerations and decelerations, and sudden directional changes. Symptoms may range from intermittent episodes of mild discomfort to severe and chronic career-ending pain. Groin injuries may result from a variety of causes. Although this article deals mainly with athletic etiologies, the physician must keep in mind that many other medical conditions may also affect the groin. Differential diagnosis of nonathletic causes of groin pain is outlined below: Intra-abdominal disorders (eg, aneurysm, appendicitis, diverticulosis, inflammatory bowel disease) Genitourinary abnormalities (eg, urinary tract infection, lymphadenitis, prostatitis, scrotal and testicular abnormalities, gynecologic abnormalities, nephrolithiasis) Referred lumbosacral pain (eg, lumbar disc disease) Hip joint disorders (eg, Legg-Calve-Perthes disease, synovitis, slipped femoral capital epiphysis in younger patients and osteochondritis dissecans of femoral head, osteoarthritis) Because of these overlapping medical conditions and because the anatomy of the region is so complex, a team approach is optimal. In the National Institute for Groin Injuries, primary care sports physicians coordinate input from a team of urologists, neurologists, radiologists, interventional radiologists, orthopedists, general surgeons, gynecologists, physical therapists, and gastroenterologists. The primary care physician, in addition to performing a focused history and physical examination, should have an understanding of the diagnostic imaging available and a working knowledge of the sensitivities and specificities of each test. After generating a complete differential diagnosis, appropriate referral when needed, and formulation of a treatment plan, the coordinating physician must diligently maintain oversight of the athlete's response to initial conservative management. This is paramount not only because of the difficulty of diagnosis, but also because 27% to 90% of patients presenting with groin pain have more than one coexisting injury [3,4]. As the authors will illustrate, these coexisting injuries are thought to arise due to the close proximity of anatomical elements in the region, predisposing one insult to naturally involve adjacent structures. Alternatively, an initial injury may alter the delicate biomechanics of the hip and groin, leading to secondary overuse injuries. Whatever the reason, it is common for one injury to be properly diagnosed and be improving with treatment, while at the same time a concomitant injury may have gone entirely undiagnosed and untreated, leaving both the athlete and physician frustrated if proper monitoring and re-evaluation are not done. In the second of this two-part series, disorders of the os pubis, stress fractures and various hip pathologies are reviewed as causes of groin pain.
