Groin Pain: Causes of Hip Joint Symptoms

The groin is the most common location to feel hip joint pain

groin pain
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When people experience pain in their lower abdomen, where the lower extremity meets the pelvis, they often refer to this as groin pain. Groin pain can be caused by a wide variety of medical conditions, and sometimes the source of pain may be from different anatomic areas. Problems in the lower abdomen, problems in or around the hip joint, and problems in the scrotum (in men), can all lead to symptoms of groin pain.

From an orthopedic standpoint, groin pain is often a sign of problems in or around the hip joint. Pain within the hip joint is most often – but not always – experienced in the groin. Pain over the outside of the hip is usually not caused by a hip joint problem and is more commonly related to hip bursitis or a pinched nerve in the back. Pain behind the hip is more commonly coming from the lumbar spine. It is pain that is deep within the groin that is often a sign of a problem within the hip joint.

Where Is the Hip?

Most people who are asked to point to their hip will instinctively point to the outside of their body. As you might expect, the hip joint is actually located deep inside the body at the junction of the pelvis and the top of the thigh bone (the femur). So why do hip joint problems hurt in the groin?

Just as patients with a heart attack may experience arm pain or patients with gallbladder problems may experience shoulder pain, patients with hip problems usually complain of groin pain. This is called "referred pain," and it is due to the organization of nerves in our body.  While the groin do not be what you would point to your hip, it is where your body tends to experience symptoms of a hip joint problem.

The best way to determine if the hip joint is the cause of your groin pain is to lie down and have an examiner move your hip through different motions. If this replicates your symptoms of groin pain, then the hip joint is likely the source of these symptoms.  People with hip joint problems often complain of discomfort with maneuvers that involve flexion (bending) and rotation of the hip joint. This would be a maneuver such as resting your ankle upon your thigh while in the seated position to put on your shoes or socks. People with hip joint problems often complains of difficulty getting her socks on because of challenges of putting her leg into this position. In medical terms, this is called a FABER maneuver (Flexion, ABduction, External Rotation), or 'Patrick's Test'.

Causes of Groin Pain

Determining the cause of groin pain symptoms is the essential first step in order to guide the most appropriate treatment. As stated earlier, there are a number of different causes of groin pain. For the purposes of this discussion, we will separate these possible sources of groin pain into:

  1. Condition-related causes of groin pain
  2. Injury-related causes of groin pain
  3. Other sources of groin pain

Condition-Related Causes of Groin Pain

There are a few orthopedic conditions that commonly lead to symptoms of groin pain. The most common of these include:

  • Hip Arthritis: Arthritis of the hip joint occurs when normally smooth junction of the top of the thigh bone with the pelvis (the hip joint) is worn away. This ball and socket joint allows for smooth, pain-free motion of the lower extremity. When the cartilage is worn away, these movements become painful and stiff. Treatments of hip arthritis usually start with simple steps, but may progress to interventions including hip replacement surgery.
  • Osteonecrosis: Osteonecrosis, sometimes called avascular necrosis, is a medical condition that causes bone cells to die as a result of lack of appropriate blood supply. When the bone cells supporting the hip joint lack a normal blood supply, they begin to collapse allowing for deterioration of the hip joint. Sometimes osteonecrosis causes only limited damage, where as other times it can lead to hip replacement.
  • Femoral Acetabular Impingement: Femoral acetabular impingement, abbreviated FAI, is generally thought of as a early stage of arthritis in the hip joint. When bone spurs developed around the ball and socket of the hip joint, this leads to restrictions in mobility of the hip and pain at the limits of motion. There has been increasing interest over the last decade about the treatment of FAI with hip arthroscopy.

    Injury-Related Causes of Groin Pain

    Groin pain that is sudden in onset and follows an event or sports injury is typically related to one of the following conditions:

    • Groin Strains: A muscle injury, called a strain, is probably the most common cause of groin pain. Unfortunately, many other problems that knee to groin pain are often misdiagnosed as a muscle strain. Muscular strains typically occur as a result of an athletic injury or awkward movement of the hip joint. Usually the onset is abrupt, and the cause of pain is clear. Treatment of a groin strain can usually be accomplished with some simple steps.
    • Hip Labrum Tear: The labrum of the hip joint is a layer of cartilage that wraps around the ball of the ball and socket joint. Much like a meniscus tear in the knee, a hip labral tear can cause symptoms of pain, catching, and popping within the hip. Hip labral tears are often diagnosed as athletic injuries and can lead to difficulty with certain movements of the hip joint. Not all labral tears of the hip require surgical intervention, but sometimes an arthroscopic hip surgery is an option.
    • Sports Hernia: A sports hernia is an unusual injury that is attributed to a subtle weakening of the abdominal wall. Sports hernias have been diagnosed mostly in soccer and hockey players, and causes pain directly over the front of the lower abdomen/groin region. A sports hernia can be difficult to diagnose, and usually the only treatment is rest or surgical intervention.

      Other Sources of Groin Pain

      There are also other causes of groin pain that may not be related to the hip joint, or an orthopedic condition. These also need to be considered when evaluating someone with a complaint of groin pain.

      Groin Pain in Children

      Joint problems in children must be considered slightly differently than in adults. While many children to experience groin pain when they have hip joint problems, children in particular tend to also experience pain going down the thigh and often into the knee. A young child with a complaint of knee pain without a clear knee joint problem needs their hip carefully examined to see if that could be a source of pain. There are several childhood conditions of the hip joint including slipped capital femoral epiphysis or Perthes disease that can lead to these symptoms.

      Tests to Diagnose a Hip Problem

      Different tests can be performed to evaluate the source of groin pain. The most commonly performed test is an x-ray. X-rays can be helpful at showing the bony anatomy and structure of the hip joint. An x-ray is the best test to determine the extent of cartilage damage and arthritis. While x-rays don't show the soft-tissues surrounding the joint, they do show a lot of anatomy to help your physician narrow down the possible sources of pain.

      An MRI is a test that is often performed to evaluate the soft tissues around the joint. MRIs can show muscles, tendons, ligaments, and labrum to help determine the source of groin pain issues. Sometimes the MRI is performed with an injection of a solution called contrast to better show subtle injuries of the cartilage and labrum inside the joint.

      Finally, a diagnostic or therapeutic injection into the hip can be very helpful if the source of pain is unclear. A skilled physician, sometimes an orthopedic surgeon or radiologist, can guide a needle into the hip joint. This may be done with the aid of ultrasound or x-ray to ensure the needle is properly positioned. Once the needle is in the joint, an anesthetic (lidocaine) or medication (cortisone) can be injected. The anesthetic is a very useful diagnostic tool—if the pain goes away temporarily the source is likely where the anesthetic was injected. The cortisone is often an effective treatment that may even provide long-term relief of symptoms.

      A Word From Verywell

      There was a time when orthopedic physicians understood groin pain to be limited to arthritis and muscular injuries. The understanding of sources of groin pain has expanded greatly, and while this can help to guide treatment, it can make for a difficult diagnostic evaluation. Working with your physician to help determine the source of pain can help guide the most appropriate treatment. Once the source of groin pain is clearly understood, a treatment plan can be developed that will hopefully lead to improvement in your symptoms.