Groin Pain: Causes of Hip Joint Symptoms

The groin is the most common location to feel hip joint pain

groin pain
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Groin pain is often a sign of problems within the hip joint. Pain within the hip joint is most often – but not always – experienced in the groin. Pain over the outside of the hip is usually not caused by a hip joint problem and is more commonly related to hip bursitis or a pinched nerve in the back.

Where Is the Hip?

Most people who are asked to point to their hip will instinctively point to the outside of their body.

 As you might expect, the hip joint is actually located deep inside the body at the junction of the pelvis and the top of the thigh bone (the femur). So why do hip joint problems hurt in the groin?

Just as patients with a heart attack may experience arm pain or patients with gallbladder problems may experience shoulder pain, patients with hip problems usually complain of groin pain. This is called "referred pain," and it is due to the organization of nerves in our body.

The best way to determine if the hip joint is the cause of your groin pain is to lie down and have an examiner move your hip through different motions. If this replicates your symptoms of groin pain, then the hip joint is likely the cause of these symptoms.

Causes of Groin Pain

Conditions of the hip joint that cause groin pain include:

However, there are also other causes of groin pain that may not be related to the hip joint.

Groin pain can also be caused by muscle pulls (groin strains), hernias, and pinched nerves in the back.  Your doctor should be able to determine by examining you the location of the problem. As stated, hip joint problems can be identified by moving the hip joint and seeing if the symptoms occur. If not, some of these other causes of groin pain must be carefully assessed.

Hip joint problems can also cause pain that occurs in other areas, not just the groin.  The groin is the most common location for hip joint pain, but pain can also occur in the back of the hip (the buttocks), the thigh, and even in the knee. In children, the knee is actually the "classic" location of pain from a hip joint problem. Therefore, any child who has the spontaneous onset of knee pain must be carefully evaluated for a hip joint problem. One of the classic findings of slipped capital femoral epiphysis or Perthes disease of the hip is knee pain.

Tests to Diagnose a Hip Problem

Different tests can be performed to evaluate the source of groin pain. The most commonly performed test is an x-ray. X-rays can be helpful at showing the bony anatomy and structure of the hip joint. An x-ray is the best test to determine the extent of cartilage damage and arthritis. While x-rays don't show the soft-tissues surrounding the joint, they do show a lot of anatomy to help your physician narrow down the possible sources of pain.

An MRI is a test that is often performed to evaluate the soft tissues around the joint. MRIs can show muscles, tendons, ligaments, and labrum to help determine the source of groin pain issues.

Sometimes the MRI is performed with an injection of a solution called contrast to better show subtle injuries of the cartilage and labrum inside the joint.

Finally, a diagnostic or therapeutic injection into the hip can be very helpful if the source of pain is unclear. A skilled physician, sometimes an orthopedic surgeon or radiologist, can guide a needle into the hip joint. This may be done with the aid of ultrasound or x-ray to ensure the needle is properly positioned. Once the needle is in the joint, an anesthetic (lidocaine) or medication (cortisone) can be injected. The anesthetic is a very useful diagnostic tool—if the pain goes away temporarily the source is likely where the anesthetic was injected.

The cortisone is often an effective treatment that may even provide long-term relief of symptoms.

Source:

Johnson R. Approach to hip and groin pain in the athlete and active adult. Grayzel J. (Ed.) In: UpToDate. 2017.

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