Table 2 Patho-anatomical approach: medial to the groin triangle (diagnoses appear in order of frequency in an athletic population)
Define and alignPathologyListen and localisePalpate and re-createAlleviate and investigate
Medial to triangleAdductor/gracilis enthesopathyInsidious onset, diminished performance, warms upProximal adductor pain, at enthesis. Guarding, weakness9 10Magnetic resonance imaging11
Adductor longus pathology at musculotendinous junctionAcute onset, worse during exercisePain in proximal adductor10Magnetic resonance imaging11
(2–4 cm distal to enthesis), guarding, weakness9 10
Pubic bone stress injuryPain primarily at pubis radiating to proximal thighBone tenderness, lack of point muscular tendernessMagnetic resonance imaging11 31
Stress fracture inferior pubic ramusInsidious onset, heavy training loadHop test,32 associated deep buttock painPlain x ray, magnetic resonance imaging33
Nerve entrapmentClaudicant-type pain of medial thigh, which settles on resting34Exercise-related adductor weakness, superficial dysesthesia of mid-medial thigh35Electromyography of adductor longus36
I. Obturator nerveGuided local anaesthetic injection to obturator foramen37
II. Ilioinguinal nerveAltered skin sensationDysaesthesia/hyperaesthesia over area of skin supplied by nerve in question24 25Relief of pain by ultrasound-guided local anaesthetic infiltration27
III. Genitofemoral nerve (genital branch)Post inguinal surgery?Nerve conduction studies7
External iliac artery endofibrosisThigh discomfort post high-intensity exercise mainly in cyclistsExercise-related lower limb weakness, exercise-altered bruit and ankle/brachial index38Doppler ultrasound39