Several other diagnoses must be considered in patients with groin pain, including other musculoskeletal disorders, as well as more severe visceral problems. Problems that we have encountered in patients with inguinal pain include inflammatory bowel disease, prostatitis, aseptic necrosis of the hips, herpes, pelvic inflammatory disease, and rectal or testicular can-cer.101 These other possible diagnoses emphasize the importance of a detailed, careful history and physical examination. Musculoskeletal syndromes commonly considered in the differential diagnosis of lower abdominal or groin pain in the athlete include adductor injuries,102 piriformis and hamstring syndromes,65'102-104 snapping hip syndrome,101 iliopsoas tendonitis,105 iliotibial band syndrome,102 sacroiliac sprain,96 osteitis pubis,16 stress fractures,106 soft tissue injuries,101 contusions,105 bursitis,107 and myositis ossificans.96
FIGURE 5.19. Plyometrics (single-leg lateral hops). This exercise is performed as a continuum to the two-feet lateral hops. The athlete performs small, quick, side-to-side hops over a line on the floor using only one foot. The duration of the exercise may also begin at 30 seconds and progress to 1 minute or more.
Athletic pubalgia in female athletes is very rare. Although the exact reason for this is unknown, it is hypothesized that anatomic differences in the pelvis may play a major role. Although athletic pubalgia is a possible cause of groin pain in women, endometriosis-
associated lower abdominal or inguinal pain is much more common.
Other sources of groin pain in women have been noted to be ovarian cystic disease, pelvic inflammatory disease, symptomatic Crohn's disease, and men-strually cyclical nonexertional pain that was without a known cause. It has also been suggested that with a direct connection between the uterus and frequent finding of endometriosis embedded in the round ligament that traction has something to do with the accompanying pain. If one of these pathologies is suspected, then laparoscopy is suggested to confirm and correct any abnormality that may be present.
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