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Causes of Pain in the Hip and Groin Area

by
author image Kerrie Reed, M.D.
In practice since 2001, Kerrie Reed is a professor of physical medicine and rehabilitation at Rush University Medical Center and a physician at Chicago Sports and Spine. Reed earned her M.D. from the University of Texas and her Bachelor of Arts in English from Duke University. She was first published in "Chicago Athlete" magazine in 2007.
Causes of Pain in the Hip and Groin Area
The hip/pelvic complex is anything but simple. Photo Credit xray image by JASON WINTER from Fotolia.com

Athletes, especially those in fast-footed sports, are particularly prone to hip and groin injuries. In fact, one study from Denmark found that 22 percent of all injuries suffered by organized soccer players involved the groin/thigh. Mechanisms of hip and groin pain may be traumatic, but they most often are due to overuse. The sheer variety of potential pain sources warrants a methodical evaluation.

Muscle Related

Muscle strains are the most common cause of pain in the hip and groin region. They typically occur in the adductor muscles along the inner groin, hip flexors along the front groin and abductors such as the tensor fascia lata along the outside hip, sometimes referred to as IT band syndrome. While there is no definitive diagnostic test for this type of problem, reproducing the symptoms by actively contracting the muscle, especially against resistance, strongly suggests a strain.

Joint Related

If the pain is along the groin line or hip crease, there's a good chance it relates to an issue within the hip joint itself. Osteoarthritis is the most common culprit in that regard, but a tear in the cartilage lip of the joint, or labrum, a painfully restrictive joint capsule, and a condition called avascular necrosis of the hip, or AVN, constitute other possibilities. Of these, AVN, in which part of the bone dies due to the loss of blood flow, is the most serious condition and must be considered if the person has been treated with oral steroids. Physical examination generally narrows down the diagnosis, and X-rays usually suffice to evaluate the bones. Labral and capsule problems don't necessarily require imaging, but if so, an MR arthrogram is the test of choice. For this, a physician injects dye into the joint just before taking the MRI.

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Stress Fracture

One should suspect a stress fracture anytime there is persistent, deep pain in the hip or groin region, particularly if weight-bearing or landing on the limb exacerbates it. MRI and bone scan diagnose it. The pubic bone and femur are common sites for these fractures, and the specific location determines the seriousness. The femoral neck--the part up by the hip joint--poses the most debilitating complications and requires the most aggressive treatment. In general, improper or sudden changes in training regimen put one at higher risk for stress fractures.

Bursitis

A bursa is a fluid-containing area between muscles or between bone and tendon that reduces friction during movement. When it becomes irritated and inflamed, it is called bursitis and is usually painful with movement and to the touch. Trochanteric bursitis manifests on the outside of the hip, while psoas bursitis occurs in the front of the groin/thigh. Although the pain may feel vague, palpation should pinpoint it fairly easily.

Nerve Related

Several nerves around the region can become injured, as well as some around the spine that refer pain to the region. Though often difficult to distinguish, nerve-related pain tends to burn or tingle, and having history of activities known to cause this, such as heavy cycling, can be a clue.

Miscellaneous

Several other potential causes of hip and groin pain bear mentioning. Osteitis pubis is an inflammation of the pubic joint in the middle, front pelvis. Also, hernias in the groin or just above the groin can produce pain. And finally, gynecological or urological issues could be possible culprits. These include prostate and testicular inflammation in men or endometriosis and vaginal infections in women.

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