Disclosures: Derek S. Day, MD: No financial relationships or conflicts of interest

Case Diagnosis: Lumbosacral spondylosis presenting with chronic groin pain.

Case Description or Program Description: A 60-year-old female presented with several months of right groin pain without inciting event or trauma. She had a history of osteoarthritis and right total hip arthroplasty with revision four years prior. She was initially seen by orthopedic surgery out of concern for hardware loosening; however, this was considered less likely based on repeat hip radiographs. The patient described a constant ache in the right groin aggravated by ascending stairs. She denied pain distal to the groin, sensory changes, weakness, and bowel/urinary incontinence, but did endorse bilateral low back pain aggravated by prolonged standing and walking. A course of physical therapy yielded minimal improvement. Physical exam was notable for full range of motion of the hip, but limited flexion, extension, and rotation of the lumbar spine. Log roll, FADIR, and straight leg raise were negative, but groin pain was reproduced by FABER and lumbar facet loading on the right. MRI of the lumbosacral spine demonstrated multilevel spondylosis with facet arthropathy most prominent at L4-5, moderate-severe spinal stenosis, and moderate-severe L5-S1 foraminal stenosis.

Setting: Outpatient sports medicine clinic

Assessment/Results: History, examination, and imaging findings prompted a diagnostic and therapeutic corticosteroid injection of right L4-5 and L5-S1 facet joints, which resulted in near-complete relief of both right groin and low back pain for two to three weeks.

Discussion (relevance): Though lumbar facetogenic pain more commonly refers to the low back, buttock, and posterior thigh, it can refer anteriorly to the groin. Altered biomechanics at the hip due to facet arthropathy can also contribute to groin pain. In such patients, management of spine pathology can also address the hip.

Conclusions: Groin pain should always prompt an evaluation for both hip and spine pathology. This patient avoided revision THA as management of lumbar facet arthropathy yielded significant improvement in function and pain.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/groin-pain-as-primary-presenting-symptom-of-lumbosacral-spondylosis/