What is the Cause of Groin Pain?
The most common cause of groin pain is an injury to the adductor longus tendon, for two reasons. First, the adductor longus has the greater angle of attachment than other hip adductors. So with abduction of the hip, the adductor longus is the first of the hip adductors to feel the strain. Second, the adductor longus has a very narrow attachment to the bone when compared to the other hip adductors.
This injury is most commonly experienced by athletes involved in sports that have rapid changes in direction, such as soccer and hockey. The pain will be high on the inside of the thigh and get worse with adduction of the hip against resistance. Jogging or running in a straight line usually does not cause pain. Often, the pain will get better with rest.
On physical examination, the adductor longus tendon is easily palpable high on the medial aspect of the thigh. Palpation of the enthesis, or origin, will often reproduce the pain. Often a small defect can be identified on the anterior aspect of the tendon. Seldom is the tendon actually torn off the pelvis.
I confirm the diagnosis by injecting the origin of the adductor longus injection with a local anesthetic such as Marcaine. If after the injection the patient has immediate relief, then that confirms the diagnosis. Patients are often anxious to get an imaging test. A MRI or Ultrasound can be used to image the injury but are not usually required. I use imaging tests as needed to confirm a diagnosis.
Non-Surgical Treatment: A steroid injection will often provide significant long term and sometime permanent pain relief. Occasionally, a second or third injection is required. There is no loss of tensile strength of the tendon after the injections. Review the article from Dr. Schilders. He reports a series of excellent results, especially with injures that appear minor on the MRI.
Surgical Treatment: An adductor longus tenotomy is effective treatment. The distal end of the adductor longus tendon should be sown to the fascia or the adductor brevis to prevent the tendon from retracting too far down the leg. It is also important to check the origin of the gracilis tendon as this occasionally requires treatment and can be a cause of continued pain if overlooked. Be sure to completely release the adductor longus. A incomplete release can cause persistent pain and require a second operation. Review the article (pdf) by Christian Akermark.
Please contact me if you have any questions. Comments are always appreciated.
I flew in from FL and had my surgery 2 years ago this Aug. I was back playing hockey in 10 weeks and haven’t skipped a beat since.
Dear Rob,
I am glad that you are still enjoying Hockey.
The San Jose Sharks need some help. They were just not fast enough to win the Stanley Cup. I forwarded your name to their head coach. Good luck.
Dr Brown
you repaired my sports hernia about 4 years ago. still doing well.
Dear Dave,
I am glad that you are doing so well. Part of the reason for the good result is I had good material to work with.
Best wishes.
Hope you are well Dr. Brown. Since seeing you over a year ago and getting your help in determining that I had regular inguinal hernia instead of a sports hernia, I had that hernia repaired down here in Los Angeles where I live and have had no trouble with it since, so thank you for your help on that.
In the meantime, I’ve been having pain in this exact area, exactly as you describe above. I’m guessing it is inflammation to the adductor longs tendon, as I can still play soccer twice a week but I definitely feel pain when I play and afterwards that affects my overall play.
Do you know of or can you recommend any doctors down here in the Los Angeles area that would be able to examine me and possibly perform an injection like the one you describe above? Or would I have to travel up your way to do this?
Thank you again.
Dear Doug,
I am glad that you are doing well. The surgeon that fixed your hernia should be able to inject the adductor longus for you. If the surgeon has any questions you can ask him/her to contact me.
If you are in the Bay Area I would be pleased to see you anytime.
Hello Dr. Brown, this is a patient from Fargo,ND. you removed a mesh from a prior sports hernia repair i had performed in fargo. Since your visit in 2012 in fremont i have been doing great. It took about 6 months to recover because of the mesh removal, but After a strict rehab program i’m almost back to where i was before my injury 10 years ago.. Thank you Dr. Brown
Dear L.L.,
Your case is an example of why I do not like to put mesh into athletes. The pain is often debilitating.
Six months is not an unusual amount of time to recover from such an extensive operation, but I glad that your body is finally healed. I hope that you are also feeling ten years younger.
Hello Dr Brown,
My left groin is doing well after SH surgery several years back. No other surgeon could make the right diagnose and as result of this I was running out of ideas what happened to the area that was operated when I was child. I am glad that no mesh was used, specifically taking into account the fact that this groin has been already operated. Your technique allowed addressing the right problem without any complications with older surgery that was done with mesh. No mesh removal was necessary – just tissue repair with sutures, which is great! Although the suture repair is known as more invasive in comparison with mesh technique, it addresses the problem right way.
My recommendations to others who suffers from this injury is to first take 4-5 months off sports and let it heal on its own. Of course, there is no guarantee that this will happen, especially if the defect is large enough. If the problem still exist then Dr Brown will definitely address the issue with pure tissue repair. I have resumed my soccer activities in about 3 months after repair, which I consider as a quick recovery for ~40 years old man with previously operated groin. My compliments to Dr Brown.