Groin Pain
What is groin pain?
Pain felt in the lower abdomen, where the leg meets the pelvis, is known as cramp pain. Groin pain is not itself a medical problem, but rather a symptom of an underlying cause. While the most common cause of groin pain in adults is a muscle strain, it can also be caused by a wide variety of other conditions, including kidney stones, inguinal hernia, problems with certain nerves in or around the hip joint. Depending on the underlying cause, groin pain can be mild or severe, come on gradually or suddenly, or feel dull, sharp, throbbing or burning.
Causes
Why does groin pain occur?
Because of the many unrelated causes of groin pain, it is important to see a health care professional for evaluation. Common causes of groin pain include: – Groin strain,
Inguinal hernia,
Kidney stones,
Hip osteoarthritis,
Femoral acetabular impingement,
Hip labrum tear,
Hip fracture,
Osteonecrosis or sports hernia of the hip is found.
Among the rarer causes of groin pain;
Testicular problems,
Neurological and nerve problems,
Conditions originating in the abdomen or pelvic area,
Osteitis pubis,
It could be a joint infection or a tumor.
A groin strain, also called a pulled groin muscle, typically occurs as a result of injury or awkward movement of the hip joint for an athletic reason. This can cause the inner thigh muscles to stretch or tear. Groin strain pain is commonly sharp, starts suddenly and in many cases the cause of the pain is obvious. In addition to this pain, the
individual may develop muscle spasms and leg weakness due to the tension present in the inner thigh area.
An inguinal hernia occurs when fatty tissue or intestines herniate or protrude through a weak or torn area in the abdominal wall. In some cases, an inguinal hernia does not cause any signs or symptoms. In cases where symptoms are evident, individuals often report a pulling sensation in the groin area and/or dull groin pain when coughing or lifting something. In addition to this pain, there may be a noticeable swelling in the groin area. A kidney stone can cause waves of pain, renal colic, as it passes through the urinary tract. The pain from this can range from mild to severe and usually occurs on the side of the trunk between the ribs and buttocks or in the lower abdomen. In both cases, the pain often radiates into the groin. In addition to the pain, the individual may experience signs and symptoms such as nausea or vomiting, pain when urinating and urge to urinate and blood in the urine.
Arthritis of the hip joint, located between the upper part of the thigh bone and the pelvis, occurs when the normally smooth hip joint wears out. When the cartilage over the joint wears away, leg movements become painful and stiff. In hip joint arthritis, as in other forms of osteoarthritis, the pain worsens with physical activity and is relieved by rest. In addition to pain, there may be stiffness in the hip joint during movement and a slight popping sound or sensation.
Femoral acetabular impingement is often considered by medical professionals as an early stage of arthritis in the hip joint. When bony protrusions develop around the hip joint, this leads to both restrictions in the mobility of the hip and pain felt in the groin or on the outside of the hip when the hip’s range of motion is strained. The pain can range from a dull ache to a sharp, stabbing sensation.
The labrum of the hip joint is a layer of cartilage that surrounds the ball and socket of the ball-and-socket hip joint. A hip labral tear can cause pain symptoms in the groin or buttocks, which are often felt sharply during certain movements of the hip. In some cases, individuals also experience a feeling of catching and popping in the hip.
A hip fracture, i.e. a bone break in the upper quarter of the femur, can be caused by a fall or a direct blow to the hip, as well as by osteoporosis, cancer or stress injury. The pain of a hip fracture is usually felt in the groin and is significantly aggravated when any attempt is made to bend or rotate the hip.
Osteonecrosis, sometimes called avascular necrosis, is a medical condition that causes bone cells to die due to lack of proper blood supply. The first symptom of hip osteonecrosis is usually a dull or throbbing pain in the groin or hip area. As the condition progresses, the individual may limp due to difficulties in putting weight on the hip.
A sports hernia is an unusual injury, mostly diagnosed in soccer players and attributed to the thinning and weakening of the abdominal wall. This type of hernia causes pain directly in the front of the lower abdomen or groin area. Diagnosing a sports hernia can be difficult. Apart from rest, the only treatment for this condition is surgical intervention.
Less commonly, testicular, abdominal, pelvic and nerve disorders can cause groin pain. Several different testicular conditions such as epididymitis or testicular torsion can cause groin pain.
Epididymitis is inflammation of the epididymis, a duct located behind the testicles. Epididymitis pain can start in the groin and then move down towards the testicle. Less common signs and symptoms of the condition include testicular swelling with fever and chills.
Testicular torsion is a surgical emergency that causes severe and sudden groin and testicular pain when the spermatic cord, the structure that carries the nerves to the testicles, is twisted on itself. A pinched nerve in the lumbar, lower spine area can cause pain, numbness and tingling in the groin area. This condition is called lumbar radiculopathy. Similarly, in cases such as obturator nerve or ilioinguinal nerve compression, it is possible to observe burning sharp groin and mid-thigh pain as well as other neurological symptoms such as numbness and tingling.
Certain abdominal conditions, such as diverticulitis or abdominal aortic aneurysm
or pelvic conditions, such as ovarian cyst, can cause pain that goes to or feels like it is in the groin.Osteitis pubis is the name given to an infection that develops on the pubic symphysis, a cartilaginous joint that connects the two pubic bones. It can cause dull, constant pain in the groin and pelvis. This can occur especially in individuals with a history of inflammatory arthritis, pregnancy, pelvic trauma or pelvic surgery. Joint infection or a tumor are rare causes of groin pain. In rare cases, the hip joint can become infected. This is commonly seen in people over 80 years of age, people with diabetes mellitus, people with rheumatoid arthritis, people with recent joint surgery, or people with hip or knee replacement. In addition to severe groin pain that increases with leg movement, signs and symptoms such as fever, swelling, warmth and redness around the hip may be observed.
In very rare cases, a tumor that develops in a muscle or bone, especially in the area of the inner thigh muscles, can cause groin pain. Groin pain caused by a tumor is usually not aggravated by exercise, unlike other types such as groin strain.
Individuals with severe and persistent groin pain, who have recently fallen or experienced other trauma to the hip should seek medical attention immediately. Groin pain associated with fever, chills, blood in the urine, abdominal or pelvic
discomfort, nausea or vomiting, inability to lose weight or walk also requires immediate medical attention. Individuals who experience symptoms of illness around the inguinal hernia such as severe pain, groin swelling, vomiting, diarrhea or swollen abdomen should seek emergency medical attention. This may indicate a strangulated hernia where the herniated tissue is trapped without adequate blood flow and requires emergency surgery.
Finally, individuals experiencing severe and unilateral testicular pain or swelling should seek emergency medical attention for a possible testicular torsion requiring immediate surgical intervention.
Diagnostic Methods
How to Diagnose the Cause of Groin Pain
In order to diagnose the underlying cause of pain in the groin, the doctor first performs a physical examination and aims to learn about the patient’s health history by asking various questions. The individual should discuss all the symptoms they observe with the doctor during this examination and share information about any other conditions or diseases they may have. The doctor will ask the individual questions to help determine the characteristics of the groin pain, such as when it started, whether there has been an acute injury or trauma, what makes the pain worse and better, and whether there are other associated symptoms. After the physical examination, the doctor will usually order imaging tests to confirm the diagnosis. During the physical examination, the doctor may perform an abdominal examination, a testicular examination in men, a neurological examination, and a musculoskeletal examination focusing on the hips. Individuals with hip joint problems often report discomfort with maneuvers that involve bending and rotating the hip joint. To confirm this, the doctor may have the individual perform the Patrick test, which measures hip flexion, abduction and external rotation. This test is a maneuver in which the individual places the ankle on the thigh while sitting down to put on shoes or socks. A case of a crunch strain can be diagnosed by physical examination alone, but other causes of crunch pain often require imaging tests to be performed.
The most commonly used imaging test to get to the underlying cause of groin pain is an X-ray, which can help to show the bony anatomy and structure of the hip joint. X-rays are also the best test to detect other signs of hip osteoarthritis, such as bone spurs and joint space narrowing, and to measure the extent of cartilage damage.
In cases where groin pain is suspected to be related to the testis or hernia, an ultrasound may be ordered. If a kidney stone is among the potential causes, the healthcare professional may opt for a computed tomography (CT) scan. An ultrasound
or CT scan of the abdomen/pelvis may also be ordered if intestinal or other abdominal/pelvic processes are suspected as causes of the groin pain.
To evaluate the soft tissues around the hip joint, a magnetic resonance imaging test, or MRI for short, is usually performed. Magnetic resonance imaging can show the muscles, tendons, ligaments and labrum to help identify the source of your hip pain problems. In some cases, a medicated MRI is performed with an injection of a solution called contrast to better reveal subtle injuries to the cartilage and labrum within the joint. Magnetic resonance imaging can also be used to determine the presence of nerve problems, such as a pinched nerve in the back that directs pain to the groin.
في الحالات التي يكون فيها مصدر الألم غير واضح، يمكن أن تكون الحقن التشخيصية أو العلاجية مفيدة للغاية في توضيح الموقف. في هذه العملية، يقوم الطبيب أو جراح العظام أو أخصائي الأشعة بتوجيه إبرة في مفصل الورك. يمكن القيام بذلك بمساعدة الموجات فوق الصوتية أو الأشعة السينية للتأكد من إدخال الإبرة بشكل صحيح. بمجرد أن تكون الإبرة في المفصل، قد يتم حقن مخدر في المنطقة. هذه أداة تشخيصية مفيدة للغاية: إذا اختفى الألم مؤقتا، فيمكن تحديد أن مصدر الألم هو على الأرجح المكان الذي تم فيه حقن المخدر.
أساليب العلاج
كيفية علاج ألم الفخذ؟
بمجرد إجراء تشخيص دقيق للسبب الكامن وراء ألم الفخذ، فإن الخطوة التالية هي صياغة خطة علاج. يمكن أن تكون عملية العلاج لآلام الفخذ مختلفة جدا اعتمادا على السبب الأساسي. ومع ذلك، فإن الخيارات المستخدمة عادة هي تغييرات نمط الحياة، والأدوية، والعلاج الطبيعي والجراحة.
يمكن التحكم في بعض أسباب ألم الفخذ بطرق بسيطة يمكن للفرد تطبيقها في المنزل. على سبيل المثال، بالنسبة لسلالة الفخذ الناجمة عن إصابة رياضية، من المرجح أن يوصي مقدم الرعاية الصحية بالراحة، والكمادات الباردة على المنطقة المصابة، ولف الفخذ العلوي بضمادة ضغط مرنة لتقليل الألم والتورم. وبالمثل، بالنسبة لالتهاب المفاصل في الورك، قد يوصي أخصائي الرعاية الصحية بتقليل الأنشطة التي تؤدي إلى تفاقم الألم، مثل تسلق السلالم.
تستخدم الأدوية التي لا تحتاج إلى وصفة طبية لتخفيف ألم الفخذ في العديد من الحالات مثل الأعصاب المقروصة، هشاشة العظام، شفرم الورك الممزق، التهاب العظم. قد تكون هناك حاجة إلى أدوية ألم أقوى بوصفة طبية لعلاج آلام الفخذ الأكثر شدة المرتبطة بحصى الكلى أو كسر الورك أو مفصل الورك المصاب. في بعض الحالات، يتم حقن الستيرويد الذي يشبه الكورتيزون في أسفل الظهر لتخفيف آلام الفخذ، خاصة في حالة هشاشة العظام الورك.
وأخيرا، إذا كان السبب الأساسي هو عدوى، كما هو الحال في حالة التهاب البربخ، قد تكون هناك حاجة إلى المضادات الحيوية لعلاجه. تستخدم المضادات الحيوية أيضا بعد الجراحة لمفصل الورك المصاب، وهو حالة طوارئ جراحية. يجب أن تؤخذ المضادات الحيوية بشكل كامل ومنتظم للفترة التي يحددها الطبيب لمنع الميكروبات المختلفة من تطوير مقاومتها وضمان فعاليتها الكاملة.
العلاج الطبيعي هو علاج مهم للأسباب المتعلقة بآلام الفخذ. ومع ذلك، فإن توقيت الخضوع لإعادة التأهيل يعتمد على المشكلة الأساسية. قد يزود أخصائي العلاج الطبيعي الفرد بمعونة للمشي مثل قصب أو عكازات أو مشاية، بالإضافة إلى تمارين التدريس التي تساعد على تقوية عضلات الساق والورك وزيادة نطاق الحركة والمرونة.
الحالات الأخرى التي تسبب ألم الفخذ أكثر خطورة وتتطلب في بعض الأحيان جراحة طارئة، كما هو الحال في حالة التهاب الخصية أو عدوى مفصل الورك. يتم علاج عدوى مفصل الورك باستخدام المضادات الحيوية بعد الجراحة الطارئة، بما في ذلك الري والتنضير.
وتشمل الأمثلة على الجراحة غير العاجلة ولكن الضرورية إعادة استقامة الورك لالتهاب المفاصل الورك المتقدم، وجراحة الورك بالمنظار لبعض الدموع الشفرين وجراحة تخفيف الضغط الأساسية لمرض هشاشة العظام الورك.
كيفية الوقاية من ألم الفخذ؟
ألم الفخذ هو شكوى شائعة مع أسباب محتملة متعددة. ومع ذلك، هناك بعض الاستراتيجيات البسيطة التي يمكن للفرد استخدامها لمنع المشاكل المتعلقة بالورك، والتي تعد مصدرا شائعا لألم الفخذ. في المقام الأول من بين هذه هي اختيار الرياضات منخفضة التأثير التي تضع ضغطا أقل على الورك، مثل السباحة أو ركوب الدراجات. خيارات مثل الحفاظ على وزن صحي، والتدريب على التوازن لمنع السقوط – السبب الأكثر شيوعا لكسور الورك – وممارسة التمارين اليومية المعتدلة لإبطاء فقدان العظام والحفاظ على قوة العضلات يمكن أن تساعد أيضا. بالنسبة لأسباب غير متعلقة بالورك من ألم الفخذ، فإن الزيارات المنتظمة لأخصائي الرعاية الصحية للفحوصات الروتينية والفحوصات ستكون مفيدة أيضا على المدى الطويل.
