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PULL-OUT SECTION
COMPLETE HOW TO TREAT QUIZZES ONLINE
www.howtotreat.com.au
INSIDE
Assessment
Examination
Investigation
Management
The future
Case study
THE AUTHOR
ASSOCIATE PROFESSOR
MAURICE BRYGEL
director of the Melbourne Hernia
Clinic, Melbourne, Vic.
Groin lumps and pain
Introduction
PATIENTS of any age may present
with pain, a lump or a painful lump
in the groin or scrotum. Groin pain
is very common and occurs in all
age groups – including infants and
the elderly, males and females – and
for any number of different rea-
sons. 1,2 In sportspeople, for exam-
ple, it accounts for 8-15% of acute
and chronic pain problems. 3
Because of their close ana-
tomical relationship to the groin,
scrotal conditions are usually con-
sidered simultaneously. Pain may
be referred from the back or hip or
from urogenital conditions such as
a calculus. Viral and bacterial infec-

tions are additional possibilities,
particularly sexually transmitted
diseases in young males. The clas-
sic groin swelling is a hernia, either
inguinal or femoral, but there are
other common or important lumps
such as enlarged lymph nodes, an
abscess, saphena varix or a haema-
toma.
While there may be pain due to or
associated with these lumps, groin
or testicular pain alone is often a
diagnostic dilemma. Pain from over-
use, repetitive activity or increased
activity alone is often termed groin
strain but there are specific muscu-
loskeletal conditions to account for
this, such as adductor tendonitis,
osteitis pubis or rectus abdominis
tendinopathy. These often occur
concomitantly and may be labelled
sportsman’s groin or sportsman’s
hernia. 3
Two specific clinical problems are
directly groin related. The first is the
occult hernia, where an ultrasound
diagnoses a hernia in a patient with
groin pain but no hernia is detect-
able clinically. 4,5 The second is the
condition known as sportsman’s
groin. 3 This issue and its terminol-
ogy became so complex that an
international consensus meeting
was held in Doha in 2014, partly
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prompted by the high incidence of
abnormal findings in normal ath-
letes. 6 A suggested classification
was: 1. Specific conditions of the
groin such as adductor, iliopsoas,
pubic and inguinal; 2. Hip-related;
and 3. Other causes.
The ready availability of X-ray,
ultrasound, CT scans, MRI and
bone scans has added an extra
dimension to diagnosis. The author
contends these methods of inves-
tigation are not always useful and,
particularly in the case of groin pain
or hernias, can be confusing. Clini-
cal decision-making is paramount.
cont’d next page
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Australian Doctor
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