The diagnosis of longstanding groin pain: a prospective clinical cohort study

Background: Longstanding groin pain is a difficult diagnostic challenge for sports physicians, and the lack of consensus on diagnostic criteria and taxonomy makes comparison of published studies difficult. Aim: To determine the usefulness and validity of the clinical classification proposed by Holmich et al in a primary care sports medicine population. Design: Prospective cohort study. Setting: Private sports medicine clinic in London, UK. Participants: 218 consecutive cases presenting with longstanding groin pain. Interventions: Clinical assessment, diagnostic investigations and follow-up. Results: Groin pain patients ( 173 men, 45 women) presented from 23 sporting codes from professional athletes to the recreational exerciser. Men most commonly played soccer ( football) (22%) and rugby (21%), while women were most often runners (40%). 12 month follow-up was successful in 65% of cases; an accurate diagnosis was made in 89% of cases. Hip pathology (50.4%) was the most common form of injury, with pubic pathology seen in 21% of cases. Pubic pathology was most often seen in kicking sports (58%), and straight line activities most often resulted in hip pathology (39%). Those patients diagnosed with hip pathology were less likely to return to pre-morbid levels of activity than those diagnosed with pubic pathology (28% vs 15%). Conclusion: This series shows a different breakdown of injuries in a sporting population presenting with groin pain than previously reported. This reflects diagnostic difficulties in the area. The high incidence of hip pathology and the poor prognosis which this confers are worthy of note.