Review Calls for Better Recognition, Treatment of Groin-Pain Syndrome

By Anne Harding

February 19, 2020

NEW YORK (Reuters Health) - Diagnosing chronic groin pain that is not hip- or hernia-related can be difficult, but this common problem can usually be treated successfully with physical therapy and surgery if necessary, according to a new review.

"It's a very typical story for me to hear that someone has seen four or five different specialists before they saw the appropriate person who made the diagnosis or made the referral," Dr. Brian S. Zuckerbraun of the University of Pittsburgh, in Pennsylvania, told Reuters Health by phone. "People are miserable, they're often times healthy, active people who feel like their life or their passion has been taken away."

Known by many names, including sports hernia, athletic pubalgia and core-muscle injury, groin-pain syndrome affects up to 20% of athletes, Dr. Zuckerbraun and his team note in JAMA Surgery. "This ambiguous nature of nonhernia, nonhip groin pain is understandable because routine physical examination often only reveals groin tenderness, and imaging may or may not have abnormalities," they add.

Groin-pain syndrome - the name the authors prefer - is usually caused by an imbalance in force exerted on the pubic bone by surrounding muscles and tendons, and can be due to pathology of the inguinal canal or pubic bone or injury to the rectus abdominus or adductor longus muscles and tendons, they explain.

Surgical treatment typically involves rebalancing the tension among muscles and tendons around the pubic bone and relieving nerve compression if necessary.

Patients with the condition should be evaluated and treated by a multidisciplinary team including "a surgeon with expertise in inguinal pathology and the pubic joint, an orthopedic surgeon knowledgeable in treating sports-related hip pathology, and a physical therapist with proficiency in training and rehabilitation of hip pathologies," according to the authors.

Physical therapy should be the first-line treatment, Dr. Zuckerbraun said, and patients should begin to see improvement after four to six weeks. If they do not get relief, he added, patients should be evaluated for surgery.

He and his colleagues include a treatment algorithm in the article, and describe their preferred surgical approach. "Unfortunately there aren't any great head-to-head comparisons or randomized controlled trials that suggest any one approach is superior to another," he noted.

Patients from across the U.S. have consulted with him after not being able to find treatment locally, but treatment should not be so hard to find, Dr. Zuckerbraun said. "Most surgeons who treat inguinal hernias really already have the skill set to take care of this problem."

He said he would welcome a consensus conference where surgeons and sports-medicine physicians with expertise in treating groin-pain syndrome develop evidence-based guidelines on treatment and prioritize research questions.

Dr. Zuckerbraun said he hopes that recognition of the condition will improve "so the patient can be treated more expeditiously and more appropriately."

He added: "I really think that the surgical procedures can be taught more broadly and there can be more practitioners that feel comfortable treating this disease process."

SOURCE: JAMA Surgery, online February 5, 2020.