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Physical Exam Groin

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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

Inspection

  • Skin
    • Color: erythema, ecchymosis, white, black
    • Trophic changes (altered hair growth, sweat production)
    • Scars
    • Cyanosis
    • Swelling
  • Muscle tone: atrophy, hypertrophy
  • Deformity: asymmetry, rotation, amputation
  • Areas of interest
    • Lumps or swelling in the groin
    • Pubic symphysis

Palpation

  • 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

Strength


Stretching and Range of Motion

  • Passively stretch
    • Adductors
    • Hip Flexors

Special Tests


Editor’s Commentary

  • 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%

See Also


  1. Serner A, , Weir A, , Tol JL, , et al.. Can standardised clinical examination of athletes with acute groin injuries predict the presence and location of MRI findings? Br J Sports Med. 2016; 50: 1541– 1547.
Created by:
John Kiel on 20 September 2021 05:43:52
Authors:
Last edited:
10 April 2022 08:15:03
Category: