Groin pain

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A wide variety of pathologies can present with pain in the groin. The surgeon requires a Medical Tourism in India, Medical Tourism India, India Medical Tourism, Medical Tourism, Knee Replacement in India, Knee Replacement Surgery Cost, Knee Replacement Cost, Hip Replacement Surgery, Hip Replacement Cost, Cancer Treatment in India, IVF in India, Stent in Heart, Bariatric Surgery Cost, Breast Surgery  systematic and methodical approach to the diagnosis
based on a sound knowledge of the complex anatomy in the region. The history of pain should give clues as to whether the origin is visceral
(more constant) or somatic (exercise related). Each surgeon will develop their own system but it is reasonable to separate the pathologies on
the basis of the tissue involved.
Muscles
A large number of muscles takes their origin from or traverse the region of the groin. Inflammation of these musculotendinous origins or partial
tears will produce activity-related pain. The principles of assessment are careful to localize the point of maximal tenderness and then test the
muscles in that area with an isometric contraction. Muscles that frequently cause problems are the proximal insertion of rectus femoris just
distal to the anterosuperior iliac spine, the adductor musculature inserting into the inferior aspect of the pubic bone and psoas tendon as it
courses over the anterior aspect of the hip joint to the lesser trochanter.
Visceral organs
Visceral pain from pelvic organs may produce groin pain and a careful history will have elicited symptoms of systemic upset. Appendicitis,
prostatitis, urinary tract infection and gynecological disorders should always be borne in mind and dealt with appropriately.
Nerve entrapment
Lumbar spine disease causing entrapment of the higher lumbar nerve roots may produce pain radiating round the buttock to the groin. Less
commonly the ilioinguinal (in the inguinal canal) and lateral cutaneous nerve of the thigh (distal to the anterosuperior iliac spine) may be
trapped as they pass through the deep fascia.
Hernia
Male athletes who play sports that involve a lot of twisting and turning are prone to developing the ‘sportsman’s hernia’. This is really a direct
‘prehernia’ in that no bulge can be demonstrated either clinically or even with specialist scanning techniques. A hernia is a fatigue failure of
the transversal is fascia which only becomes symptomatic because of the repeated stresses placed on it by the athlete. The diagnosis is based
on the history and tenderness at the deep inguinal ring. This sign is elicited by invaginating the scrotum with the little finger until the tip can be
placed directly over the deep inguinal ring. The examination is uncomfortable and so comparison with the normal side is required. Repair is
performed in the standard manner either using a mesh or by reefing the conjoined tendon to the inguinal ligament.
Bone and joint
Osteoarthritis of the hip classically presents with groin pain, and the diagnosis should not be excluded because of normal radiographs. Plain
radiographs will usually demonstrate a stress fracture of the femoral neck but if there is still doubt then bone scintigraphy or an MRI will
establish the diagnosis.
Osteitis pubis is a well-recognized but poorly understood condition. Pain and tenderness are vaguely localized to the anterior pubic bones
and intervening symphysis. Plain radiographs may demonstrate changes of fragmentation of the margin of the pubic bones and patchy
sclerosis within the symphysis. The etiology of this condition is unknown; certainly, no pathogenic organisms have ever been demonstrated
within biopsies. Treatment is frustrating for both surgeon and athlete as it may require a prolonged period of no weight-bearing activity. Fusion
of the pubic symphysis should be avoided as the results are very poor

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