Physical Exam Groin

General

Abdominal exam should be considered depending on presentation
Groin exams should generally be performed in the presences of a chaperone
Hip exam should be performed as intra-articular hip pain can present as groin pain

Loosely broken into regions
- Inguinal Ligament
- Pubic symphysis or tubercle
- Adductor muscle group
- Iliopsoas muscle
Lump if present
- If present, characterize the nature and location
- Number of lumps (more than one suggests lymph nodes)
- Is it reducible? Worse with cough or valsalva?
- Is it pulsatile

Serner et al reviewed 81 male athletes with acute groin pain and studied their exam findings^[1]
Adductor-related
- Clinical examination is accurate in locating acute injuries to the adductors, generally with an accuracy greater than 90% for the various adductor tests.
- Specific adductor examination tests (resisted outer range adduction, adductor stretch and the squeeze test in hip neutral position) individually provided ∼80% probability of predicting a positive MRI in the adductors.
- These adductor examination tests also provided a very high probability of predicting an accurate injury location.
Hip Flexor-related
- Hip flexor pain provocation tests had poor ability to predict a positive MRI, and poor accuracy, roughly no better than a coin toss
Importantly, absence of palpation pain in the adductors and hip flexors has the highest predictive value for ruling out acute injury in these structures, with an accuracy greater than 90%