Extraarticular Sources of Hip Pain

Abstract

The task of diagnosing and managing extraarticular causes for hip and groin pain represents one of the greatest challenges in sports medicine. The differential diagnosis for hip and groin pain is broad and includes intraarticular hip disorders, acute and chronic muscular tears, pubic symphysis disorders, snapping hip syndrome, peripheral nerve entrapment, and abdominal wall abnormalities. Nonmusculoskeletal etiologies should also be considered: these include urologic disease, gynecologic disease, gastrointestinal problems, infections, and tumors. Also complicating the clinical picture is the nature of groin symptoms, which may be vague, confusing, and generalized around the hip joint, thigh, and abdomen regions. The ambiguous constellation of symptoms can be partly explained by a complex pain referral pattern around the groin and the hip region. These problems are unfortunately frequently misdiagnosed and appropriate treatment often delayed. It is evident that the evaluation of these problems, especially if chronic in nature, may be extremely demanding. Therefore, to avoid misguided treatment strategies and to ultimately ensure treatment success, a diagnostic approach that is methodical and organized must be followed. This chapter takes a comprehensive look at four infrequently encountered extraarticular disorders of the hip and groin area that can clinically mimic intraarticular hip pathology: osteitis pubis, piriformis muscle syndrome, obturator nerve entrapment, and athletic pubalgia.