Appropriate Audience: Residents and practicing physicians

(1) understand the differential diagnosis of groin pain in athletes and (2) establish a systematic approach to diagnosis and treatment of groin pain. History A 28-year-old professional soccer player presents to the training room during the second week of practice complaining of the acute onset of groin pain that day while stretching for a ball during practice. Pain is primarily at the proximal adductor tendon and less so at its pelvic insertion. Pain is exacerbated by running and by striking the ball. This patient is treated with electrical stimulation, massage, anti-inflammatories, flexibility and strengthening of the pelvic, hip, and lower extremities. Exercises are performed in both open and closed chain fashion. For the first 3 days, his sport activity is limited to running up to three-quarter speed and dribbling drills. Sprinting drills are added on day 4. Patient is progressed through a progressive addition of sports specific soccer drills so that by day 14 post-injury, he is fully released for game participation. On day 16 post-injury he removes himself from a scrimmage, reporting the recurrence of groin pain. • Prior to continuing, please develop a differential diagnosis and list each possible diagnosis in order of likelihood. Commentary I In athletes with persistent groin pain for whom initial measures fail, a broad differential diagnosis should be entertained (Table 1)