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22yo college track athlete presents with 3 weeks of gradual onset groin and thigh pain, worse with running, better with rest.
Stress fractures are a common cause of groin pain in athletes, particularly in long distance runners
Fractures occur in the pubic rami and femoral neck
Ask about a sudden change in training regimens
PE: check for tenderness to deep palpation over the pubic ramus. Ask athlete to stand and support full weight on affected leg or perform one legged hop on affected side. Pain out of proportion to physical examination findings.
Imaging: XR usually negative. Bone scans can be positive as early as 4 to 8 days after symptom onset. MRI used to diagnose and rule out other causes of groin pain.
Treatment: Rest for 4 to 6 weeks. Consider making patient non weight bearing if walking causes pain especially with femoral neck fractures on the superior side. Inferior side neck fractures may benefit from prophylactic fixation.
References
Groin Injuries (Athletic Pubalgia) and return to play. Elattar et al., Sports Health Aug 2016.