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• Conmed – Linvatec
• Consultant
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Non-Articular Sources of Groin Pain
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Non-Articular Sources of Groin Pain
Patients self-perception
Arnold DR, Keene JS, Blankenbaker DG, Desmet AA. Hip pain referral
patterns in patients with labral tears: analysis based on intra-
articular anesthetic injections, hip arthroscopy, and a new pain
"circle" diagram. Phys Sportsmed. 2011 Feb;39(1):2935
• Patients with labral tears and pain improvement after hip joint
injection
• Central groin
• Lateral peritrochanteric area Most Common
• Ischial tuberosity
• Anterior thigh
Condition Symptoms
? Peritrochanteric
Intra-articular
pathology Groin pain
“C” Pattern
?
GROIN PAIN
HIP JOINT PELVIC (FEMALE)
NEUROPATHY MUSCULAR TEARS
HERNIA SYMPHYSIS
BURSA SPINE
FRACTURES GENITOURINARY
ABDOMINAL VASCULAR-LIMPH
Athletic pubalgia
Subspine impingement
Non-Articular Sources of Groin Pain
• Males
• Athletes (football) twisting, kicking, pivoting and sprinting
• Routine imaging
• Plain X-RAY – Flamingo view
Non-Articular Sources of Groin Pain
• Routine imaging
• MRI
• Bone scan
• Reumatological disease
• Suspected stress fracture
• Ultrasound
• Suspected occult hernia
• Muscular insertions
Non-Articular Sources of Groin Pain
• Treatment:
• Conservative (rest)
Adductor-related groin pain in recreational athletes: role of the adductor enthesis, magnetic
resonance imaging, and entheseal pubic cleft injections. Schilders E, Talbot JC, Robinson
P, Dimitrakopoulou A, Gibbon WW, Bismil Q. J Bone Joint Surg Am. 2009 Oct;91(10):2455-
60
Non-Articular Sources of Groin Pain
• Surgical treatment
• Last option
• According to findings
• More 26 different procedures (repair-release tendons)
• Verrall GM, Slavotinek JP, Barnes PG, Esterman A, Oakeshott RD, Spriggins AJ. Hip
joint range of motion restriction precedes athletic chronic groin injury. J Sci Med Sport
2007. 10(6):463-6
Larson CM, Pierce BR, Giveans MR. Treatment of athletes with symptomatic intra-articular hip
pathology and athletic pubalgia/sports hernia: a case series. Arthroscopy 2011;27:768–75
• Conclusion
• Association FAI – AP (further research)
• Subspine impingement
• Anterior model of anterior extra-articular impingement
• 90º + 10 IR
Non-Articular Sources of Groin Pain
• Causes
• Physical examination:
Non-Articular Sources of Groin Pain
• Anterior Inferior Iliac Spine Morphology Correlates With Hip Range of Motion: A Classification
System and Dynamic Model. Iftach Hetsroni MD, Lazaros poultsides MD, Asheesh Bedi MD,
Christopher M. Larson MD, Bryan T. Kelly MD. Clin Orthop Relat Res (2013)
• Amar E, Druckmann I, Flusser G, Safran MR, Salai M, Rath E. The anterior inferior iliac
spine: size, position, and location. An anthropometric and sex survey. Arthroscopy. 2013
May;29(5):87481
• Conclusion