What is causing the pain in my groin when standing?

Q: I am a 60-year-old man with pain in the groin whenever I stand still for more than 10 minutes.

The pain has been bothering me for nearly two months.

The pain radiates from the upper right thigh and I have great difficulty climbing stairs after each numbing attack.

The pain disappears when I sit down and rest.

I can jog, walk briskly and even do leg presses at the gym without any pain or swelling in the affected area.

I consulted a sports medicine specialist but he could not find anything wrong with me.

I even went for traditional Chinese medicine massages and acupuncture but there has been no improvement. Please advise.

A: Pain in the groin is quite characteristic of hip joint problems.

These include osteoarthritis (wear and tear of the joint), tear of the cartilage (lining on the ends of bones), sprain of the hip ligaments (bands of fibrous tissue, each connecting a bone to another bone) or avascular necrosis (internal damage of the femoral head or ball joint due to poor blood supply).

Often, this type of pain will also radiate down the thigh, and sometimes to the knee.

As the hip joint tightens when it rotates inwards, twisting movements often aggravate the pain.

Although pain from hip problems typically get worse with physical exertion, it is possible for you not to feel any pain when you are walking or doing leg presses if the damage is localised or limited to a small part of the joint. In such cases, the hip does not engage the problem area during these straight up and down (flexion) movements.

As the hip joint is deep in the body, hip joint conditions do not usually cause swelling, except in specific serious situations such as a fracture or an infection.

One should bear in mind that other conditions, such as hernia and other types of soft tissue pathology, can cause pain in this area too, although they are often associated with swelling.

A hernia occurs when one of the structures in the body protrudes through an abnormal opening in the tissues. For instance, a groin hernia occurs when part of the intestine or the fatty tissue that surrounds it bulges through a weak spot in the abdominal wall into the groin.

Through a clinical examination and further tests, an experienced doctor should be able to identify the cause of your pain and prescribe the appropriate treatment.

If you had not had any X-rays done, this should be the initial screening investigation.

Sometimes, more specialised scans such as magnetic resonance imaging (MRI) may be needed for diagnosis, and also to rule out more serious causes such as a tumour.

A clear diagnosis is important in your case as the appropriate treatment will depend on the exact condition diagnosed.

Associate Professor Wilson Pang
Head and senior consultant at the division of hip and knee surgery at National University Hospital

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