Table 3 Patho-anatomical approach: superior to the groin triangle (diagnoses appear in order of frequency in an athletic population)
Define and alignPathologyListen and localisePalpate and re-createAlleviate and investigate
Superior to baseRectus abdominis tendinopathyWell localised to insertion, acute or insidious onsetPain from resisted sit-up.10 41 Pubic “clock”: 12Magnetic resonance imaging11
Incipient hernia; conjoint tendon tearInsidious onset, diminished performance, warms upPain on resisted “torsion” of trunk “ipsilateral direction”.16 Pubic “clock”: 11Ultrasound17
Incipient hernia; external oblique aponeurosis tearAcute onset, related to sport-specific movement, eg, “slap shot”22Pain on resisted “torsion” of trunk “contralateral direction”16Magnetic resonance imaging18
Tenderness and dilation of superficial inguinal ring on invagination of scrotum23Confirmation by direct vision at arthroscopy1921
Pubic “clock”: 12–1
Inguinal herniaPain on valsalva manoeuvreCough impulse, palpable mass at deep inguinal ring (direct), in inguinal canal/scrotum (indirect)Ultrasound17
Herniography,42 laparoscopy
Nerve entrapmentAltered skin sensationDysaesthesia/hyperaesthesia over area of skin supplied by nerve in question7 26Relief of pain by ultrasound-guided local anaesthetic infiltration27
Ilioinguinal nerve
Iliohypogastric nerveNerve conduction studies7
Genitofemoral nerve (genital branch)
Lateral femoral cutaneous nerve