General
- An abdominal exam should be considered depending on the presentation
- Groin exams should generally be performed in the presence 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
- Abdominal flexion
- Rectus Abdominis
- Hip Adduction
- Pectineus
- Adductor Longus
- Adductor Brevis
- Adductor Magnus
- Adductor Minimus
- Gracilis
- Obturator externus
- Hip Flexion
- Iliopsoas
- Pectineus
Stretching and Range of Motion
- Passively stretch
- Adductors
- Hip Flexors
Special Tests
- Hip Flexor Tendinopathy
- Thomas Test
- Sports Hernia
- Adductor Squeeze Test
- Resisted Single Adductor Test
- Resisted Bilateral Adductor Test
- Resisted Sit Up
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 ∼an 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, the 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%
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