Hubbry Logo
GroinGroinMain
Open search
Groin
Community hub
Groin
logo
8 pages, 0 posts
0 subscribers
Be the first to start a discussion here.
Be the first to start a discussion here.
Contribute something
Groin
Groin
Groin
View on Wikipedia
from Wikipedia
Left and right inguinal regions shown in lower part of diagram

In human anatomy, the groin, also known as the inguinal region or iliac region,[1] is the junctional area between the torso and the thigh.[2] The groin is at the front of the body on either side of the pubic tubercle, where the lower part of the abdominal wall meets the thigh.[3][1] A fold or crease is formed at this junction known as the inguinal groove, or crease. This is also the area of the medial compartment of the thigh that contains attachments of the adductor muscles of the hip or the groin muscles. The groin is the common site for a hernia.

Gross anatomy

[edit]

Where the lower part of the anterior abdominal wall meets the thigh, a crease is formed known as the inguinal groove or crease. The junction is the area of the medial compartment of the thigh that contains the attachments of the adductor muscles of the hip, also known as the groin muscles.

The adductor muscles that make up the groin consist of the adductor brevis, adductor longus, adductor magnus, gracilis, and pectineus.[4] These groin muscles adduct the thigh (bring the thigh and knee closer to the midline).

The groin is innervated by branches of the lumbar plexus. The pectineus muscle is innervated by the femoral nerve, and the hamstring portion of adductor magnus is innervated by the tibial nerve.[5]

In the groin, underneath the skin, there are three to five deep inguinal lymph nodes that play a role in the immune system. These can be swollen due to certain diseases, the most common one being a simple infection, and, less likely, from cancer. A chain of superficial inguinal lymph nodes drain to the deep nodes.

There are two depressions called fossae in an area called the inguinal triangle—the lateral inguinal fossa and the medial inguinal fossa.

The inguinal ligament runs from the pubic tubercle to the anterior superior iliac spine, and its anatomy is very important for hernia operations.

Clinical significance

[edit]

A pulled groin muscle usually refers to a painful strain of the hip adductor muscles.[6] This type of injury is related to risk factors including overuse and previous injury.[7][8][9]

An inguinal hernia is a hernia of the groin and can be either a direct hernia, or an indirect hernia according to its particular location. Sometimes a direct hernia may be present with an indirect hernia on the same side when it is known as a saddlebag hernia.

Like other flexion surfaces of large joints (popliteal fossa, armpit, cubital fossa and essentially the anterior part of the neck), it is an area where blood vessels and nerves pass relatively superficially, and with an increased amount of lymph nodes.

In a venography procedure, the groin is the preferred site for incisions to enter a catheter into the vascular system.

See also

[edit]

References

[edit]
[edit]
Revisions and contributorsEdit on WikipediaRead on Wikipedia

Groin

View on Grokipedia
from Grokipedia
The groin, also known as the inguinal region, is the anatomical area where the meets the upper , encompassing the fold or depression on either side of the pubic . This region includes the , a short passageway approximately 4-6 cm long in the lower anterior , situated just above the , which serves as a conduit for key structures between the and the external genitalia or . Anatomically, the is bounded by the forming the floor, the of the external oblique muscle as the anterior wall, the and as the posterior wall, and the arched fibers of the internal oblique and transversus abdominis muscles forming the roof. Its contents differ by sex: in males, it transmits the , which includes the , gonadal blood vessels, lymphatics, and nerves such as the ilioinguinal (L1) and genitofemoral (L1-L2); in females, it conveys the round ligament of the along with similar vascular and neural elements. The canal's openings include the deep (internal) ring, located lateral to the inferior epigastric vessels above the midpoint of the , and the superficial (external) ring, a triangular gap in the external oblique superior to the . Surrounding the canal are critical soft tissues, including the adductor muscle group—comprising the adductor , brevis, , gracilis, and pectineus—which facilitate thigh adduction and hip flexion. The groin is clinically significant due to its vulnerability to injury and pathology, serving as a common site for inguinal hernias, where abdominal contents protrude through weakened walls, often requiring surgical repair with reinforcement. Muscle strains or tears in the adductors represent the most frequent cause of groin pain, particularly among athletes in sports involving rapid directional changes like soccer, hockey, or , and can result from overstretching or sudden movements. Other notable conditions include from infections or malignancies, nerve entrapments leading to chronic pain, and in males, issues like hydroceles or varicoceles affecting the structures. The region's complex underscores the importance of precise , often via or physical exam, to differentiate musculoskeletal from visceral causes.

Anatomy

Definition and Boundaries

The groin, also referred to as the inguinal region, is the anatomical area located at the junction between the lower and the upper , forming a critical transition zone in the anterior . This region encompasses the passage known as the and serves as a key site for the transmission of structures from the to the external genitalia. The precise boundaries of the groin establish its spatial extent: superiorly, it is delimited by the , which extends from the to the ; medially, by the and the inferolateral margin of the ; laterally, by the inferior portion near the and the inferior epigastric vessels; and inferiorly, it gradually blends into the proximal without a distinct demarcation, often aligning with the inguinal crease. These limits position the groin approximately 1 cm superolateral to the , dividing it into medial and lateral compartments separated by the inferior epigastric vessels. Embryologically, the groin arises from the developmental processes during fetal life, particularly the formation of the concurrent with gonadal descent. In males, the testes originate in the posterior and migrate caudally through the inguinal region into the , guided by the testis, which pulls the gonads along a peritoneal outpouching called the processus vaginalis; the processus vaginalis forms around weeks 6-10 of gestation, with transabdominal descent to the inguinal region occurring between approximately 10-15 weeks, followed by inguinoscrotal descent completing between 25-35 weeks of gestation, shaping the and defining the boundaries of the groin. In females, a similar process occurs with the ovaries, though descent is less extensive, resulting in the round ligament of the uterus traversing the canal. Definitions of the groin's boundaries exhibit variations across medical literature, influenced by anatomical, clinical, and surgical perspectives. Anatomical descriptions emphasize the strict confines around the inguinal ligament and canal for structural clarity, whereas clinical contexts, such as in sports medicine, may extend the region to include the adjacent femoral triangle to encompass pain referral patterns from adductor or hip structures; surgical views often prioritize the area immediately surrounding the inguinal canal for hernia repairs, highlighting nomenclature inconsistencies that complicate diagnosis.

Superficial Structures

The superficial fascia of the groin, continuous with that of the lower anterior , comprises two distinct layers: the outer fatty Camper's fascia and the inner membranous Scarpa's fascia. Camper's fascia consists of loose areolar interspersed with adipose deposits, providing cushioning and varying in thickness based on individual body fat distribution. Scarpa's fascia, a thinner fibroelastic containing scattered fibers, adheres more firmly to underlying structures and extends inferiorly beyond the to fuse with the medially while continuing as in the ; this continuity limits the spread of superficial infections or fluids in the region. Embedded within this superficial fascia are the superficial , typically numbering 8–10 and divided into a horizontal chain immediately inferior to the and a vertical chain paralleling the . These nodes primarily drain lymphatic fluid from the superficial tissues of the lower below the umbilicus, , external genitalia, , and lower extremities, facilitating immune surveillance and fluid return; efferent vessels from these nodes converge toward the deep inguinal nodes or directly to the external iliac nodes. The skin overlying the groin exhibits specialized characteristics adapted to its transitional role between trunk and lower limb. It is relatively thin and elastic, with distribution forming a characteristic pubic over the that extends laterally toward the , emerging during under stimulation to provide protection and sensory enhancement. This skin demonstrates heightened sensitivity attributable to dense by branches of the (supplying the upper medial , , and adjacent genitalia), (innervating the or ), and (covering the perineal aspects), rendering the area responsive to light touch and prone to discomfort from irritation. Clinically, the superficial inguinal ring serves as a prominent , situated approximately 1 cm superior and slightly lateral to the within the of the external oblique muscle. involves gently invaginating the overlying skin—using the in males via the or in females—while asking the patient to , allowing detection of an expansile impulse indicative of inguinal hernias; this triangular defect, bounded by the medial and lateral crura, measures about 2–3 cm in males and is smaller in females.

Deep Structures

The is an oblique passage through the lower anterior , measuring approximately 4 to 6 cm in length, that extends from the deep (internal) inguinal ring to the superficial (external) inguinal ring, positioned just superior to the . This canal serves as a conduit for structures passing between the and the or , and its formation results from evagination of the during embryonic descent of the gonads. The anterior wall of the inguinal canal is primarily formed by the of the external oblique muscle, with reinforcement laterally by the internal oblique muscle fibers. The posterior wall consists of the throughout its length, strengthened medially by the , which is the fused of the internal oblique and transversus abdominis muscles. The roof is arched by the lower edges of the internal oblique and transversus abdominis muscles and their aponeuroses, while the floor is created by the , with medial reinforcement from the and lateral support from the . The contents of the inguinal canal differ by sex but share the ilioinguinal nerve in both. In males, the canal transmits the , which includes the , of veins, lymphatics, and . In females, it conveys the round ligament of the , a remnant of the , along with accompanying vessels and the ilioinguinal nerve. The ilioinguinal nerve provides sensory innervation to the skin of the upper medial , , and or . Passages through the inguinal canal follow two primary pathways relevant to its internal organization. The oblique pathway enters via the deep inguinal ring, lateral to the inferior epigastric vessels, and traverses the canal to exit through the superficial ring, accommodating the spermatic cord or round ligament. The direct pathway involves protrusion through a weakened area of the posterior wall, medial to the inferior epigastric vessels, without traversing the deep ring. Hesselbach's triangle represents a critical deep landmark within the inguinal region, delineating areas of potential weakness for hernia classification. It is bounded inferiorly by the , laterally by the inferior epigastric vessels, and medially by the lateral border of the . Direct inguinal hernias protrude through this triangle due to attenuation of the , distinguishing them from indirect hernias that follow the oblique path lateral to its boundaries.

Vascular and Lymphatic Supply

The arterial supply to the groin region originates from the , which continues as the common femoral artery upon passing beneath the . The common femoral artery then bifurcates into the superficial and deep femoral arteries, but prior to this division, it emits key superficial branches that vascularize the groin structures. These include the , which ascends to supply the skin and superficial tissues of the lower anterior ; the , which courses laterally to perfuse the skin over the iliac region and upper ; and the superficial external pudendal artery, which travels medially to nourish the skin of the external genitalia, or , and proximal medial . These branches typically arise 1-2 cm distal to the and form anastomoses with vessels from the , facilitating collateral circulation between the abdominal and lower limb vascular territories. Venous drainage from the groin parallels the arterial supply, with superficial veins converging on the great saphenous vein, the longest vein in the body, which courses medially along the lower limb to terminate at the saphenofemoral junction in the groin. Here, the great saphenous vein unites with the common femoral vein, just distal to the inguinal ligament, draining blood from the lower limb, perineum, and lower abdominal wall. Tributaries to the great saphenous vein in the groin include the superficial epigastric vein, which drains the lower abdominal skin; the superficial circumflex iliac vein, collecting from the lateral abdominal and iliac regions; and the superficial external pudendal vein, which returns blood from the external genitalia and medial thigh. Deep venous drainage follows the femoral artery and its branches via accompanying venae comitantes, ultimately joining the external iliac vein to return to the inferior vena cava. Lymphatic drainage of the groin is mediated by the , classified into superficial and deep groups, which serve as primary filters for from the lower body. The superficial inguinal nodes, numbering 8-10 and situated inferior to the along the , receive afferent vessels from the skin and superficial tissues of the lower , umbilicus, , , external genitalia, below the , and the entire lower limb. The deep inguinal nodes, typically 3-5 in number and located within the femoral canal medial to the , drain deeper structures such as the or , , inferior , and efferents from the superficial nodes. Efferent vessels from both groups converge and ascend through the femoral canal to join the , integrating into the common iliac and ultimately the . In clinical contexts, the sentinel —the initial node receiving drainage from a site—plays a critical role in staging malignancies of the lower limb, , or genitalia, often identified within the inguinal chain via techniques like lymphoscintigraphy.

Innervation

The innervation of the groin region primarily derives from branches of the , providing both sensory and motor supply to the skin, subcutaneous tissues, and muscles in this area. Sensory innervation to the groin is supplied by the (T12-L1), which provides cutaneous sensation to the suprapubic skin and the upper medial aspect of the or , corresponding to the L1 dermatome. The (L1) contributes sensory fibers to the skin of the upper medial , , and lateral or , also aligning with the L1 dermatome distribution. The (L1-L2) divides into genital and femoral branches; the genital branch supplies sensory innervation to the or , while the femoral branch innervates the skin of the upper anterior , reflecting L1-L2 dermatomal coverage. These nerves collectively ensure sensory feedback from the groin, with potential overlap in the region. Motor innervation to the groin muscles arises from branches of the (L2-L4), which supplies the iliacus, pectineus, and sartorius muscles, facilitating flexion and stabilization. The (L2-L4) provides motor supply to the adductor muscles (including adductor longus, brevis, magnus, and gracilis) and obturator externus, enabling adduction and rotation essential for lower limb movement. These innervations support the musculoskeletal role in locomotion and posture. Autonomic contributions to the groin include sympathetic fibers from the lumbar splanchnic nerves (L1-L2), which relay through the to influence tone in the regional smooth muscles and glands. Clinical assessment of nerve integrity in the groin often involves , elicited by percussion over the or canal to provoke tingling or along the distribution of the ilioinguinal or iliohypogastric nerves, indicating potential or . This test helps evaluate function in conditions like inguinal .

Function

Musculoskeletal Role

The groin region serves as a critical junction for musculoskeletal structures that facilitate lower limb mobility and core stability, primarily through the integration of muscles and adductors with supporting ligaments. The , formed by the thickened inferior border of the external oblique muscle's aponeurosis, extends from the to the , providing a key attachment site for the internal oblique and transversus abdominis muscles. These muscles contribute to the formation of the , which inserts onto the pubic crest and pectineal line, enhancing the tensile strength of the posterior inguinal wall. The adductor muscle group, including the adductor longus, brevis, magnus, gracilis, and pectineus, originates from the pubic bone and inferior pubic rami, enabling coordinated actions across the . In terms of movement, the internal oblique and transversus abdominis muscles generate tension to support trunk stabilization and resist intra-abdominal pressure during dynamic activities, while also aiding in forced expiration and . The adductor muscles primarily drive adduction, bringing the toward the midline, and assist in flexion—particularly the adductor longus and brevis during the initial swing phase of locomotion—while the adductor magnus contributes to extension in later phases. These actions collectively enable efficient lower limb positioning, with the adductors counteracting lateral to maintain balance. Innervation of these muscles arises primarily from branches of the , ensuring precise control during contraction. Biomechanically, the groin contributes to stability during and load-bearing, where the and experience compressive forces up to several times body weight to transfer ground reaction forces upward, with the adductor muscles playing a pivotal role in eccentric control of femoral adduction during the stance phase, preventing excessive medial collapse and distributing shear stresses along the . In load-bearing tasks, such as squatting or carrying weight, the abdominal muscles increase intra-abdominal pressure to augment spinal stability, with force vectors directed medially and inferiorly through the . Ligamentous elements further bolster this stability: the , a triangular medial extension of the fanning from the to the pectineal line, reinforces the medial and provides attachment points for adjacent musculature. The pectineal ligament, a continuation along the pecten pubis, strengthens the lacunar ligament and serves as an anchor for the , collectively resisting downward herniation of abdominal contents under load while maintaining pelvic alignment during movement.

Role in Lymphatic and Venous Return

The groin plays a crucial role in lymphatic drainage from the lower extremities, , and external genitalia, primarily through the superficial and deep , which collect and propel toward the lumbar trunks and . Lymphatic propulsion in this region is facilitated by rhythmic contractions of collecting lymphatic vessels, augmented by external forces such as activity during movement. For instance, the calf muscle indirectly aids flow to the inguinal nodes by generating intermittent gradients that compress lymphatic vessels and drive fluid upward against , supported by one-way valves that prevent . This mechanism ensures efficient clearance of interstitial fluid and immune cells from the lower body, with light exercise further enhancing drainage through repeated muscle contractions that stimulate protein and increase flow rates in the lower limbs and groin area. In venous return, the groin serves as a key junction where the superficial and deep venous systems converge, with the draining into the at the saphenofemoral junction. Bicuspid valves within the saphenous veins, particularly dense in the lower leg and tapering proximally, function to prevent by closing during periods of low pressure, allowing unidirectional flow toward the heart despite gravitational forces. These valves, combined with surrounding muscle compression, maintain venous pressure gradients essential for returning deoxygenated blood from the lower limbs, with the groin acting as a critical transition point to the deep system. During exercise, physiological adaptations in the amplify both lymphatic and venous return to accommodate increased metabolic demands. Rhythmic contractions of and groin muscles activate the pump, compressing veins and lymphatic vessels to boost flow rates—venous return increases significantly during moderate activity—while valves ensure forward propulsion without stagnation. This enhanced circulation supports oxygen delivery and waste removal, with the inguinal area's integration of superficial and deep pathways preventing overload and maintaining hemodynamic balance. The groin's role also integrates with fluctuations in abdominal pressure, as seen in the Valsalva maneuver, where forced expiration against a closed glottis elevates intrathoracic and intra-abdominal pressures, transiently reducing venous return to the heart by compressing abdominal veins and increasing peripheral venous pressures in the lower body. In the groin, this can highlight valve competency at the saphenofemoral junction, as elevated pressure tests for potential reflux, underscoring the region's sensitivity to pressure changes that modulate overall lower limb drainage.

Clinical Significance

Injuries and Trauma

The groin region is susceptible to various traumatic injuries, particularly in athletic contexts, with adductor strains being among the most prevalent, often affecting the adductor longus muscle due to its role in hip adduction. Hip pointer contusions, involving bruising of the iliac crest and surrounding soft tissues, and pubic symphysis disruptions, which represent separations of the pubic bones often as part of pelvic ring injuries, also commonly occur. These injuries typically arise from sports involving rapid movements or contact, such as soccer, hockey, or football, and can significantly impair mobility if not managed promptly. Mechanisms of injury differ between direct impact and overuse. Adductor strains result from sudden, forceful adduction against resistance, such as during sprinting, kicking, or abrupt directional changes, leading to muscle fiber tears at the musculotendinous junction. In contrast, hip pointer contusions stem from direct to the , causing formation and potential involvement of the abdominal oblique muscles or hip abductors. disruptions usually occur in high-energy anteroposterior compression traumas, like collisions or falls, where external forces widen the beyond its normal width of approximately 5 mm, often graded by the extent of posterior ligament involvement. The underlying adductor muscles and pelvic ligaments, which provide stability to the groin, are particularly vulnerable in these scenarios. Acute symptoms across these injuries include localized pain, swelling, and ecchymosis, with adductor strains presenting as sharp medial or pain exacerbated by resisted adduction or . pointers cause tenderness and bruising over the , often with hip flexion or rotation aggravating the discomfort, while pubic symphysis disruptions may manifest as pelvic instability, lower , and associated signs like or perineal in severe cases. relies on clinical examination, with MRI serving as the gold standard for soft tissue assessment in strains and contusions to detect , tears, or , and radiographs or CT for bony disruptions. Inner thigh soreness, a common presentation in groin-related injuries, is most frequently caused by strains in the inner adductor muscle group, often resulting from recent exercise such as running, squatting, or sudden movements, as well as prolonged sitting, poor posture, or muscle imbalances; it typically manifests as soreness and tenderness that worsens with activity. Other contributing factors include nerve-related issues, such as lumbar disc herniation compressing nerves or local nerve compression, which can cause radiating soreness, and occasionally pelvic conditions like prostatitis. Hip joint or groin problems, including hip arthritis, synovitis, or inguinal hernia, may lead to referred pain in the inner thigh. Rare causes involve overuse, trigger points, or vascular issues such as deep vein thrombosis, which often presents with associated swelling. Medical attention should be sought for single-sided inner thigh soreness if it persists beyond a few days without improvement from home treatment, worsens with activity, or is accompanied by swelling, radiating symptoms, serious pain, numbness, or inability to bear weight. Initial management emphasizes the protocol—rest, , compression, and —to reduce and pain, applicable to all three injury types. Adductor strains are graded from 1 (mild, with minimal fiber disruption and no strength loss) to 3 (severe, complete tear with significant weakness), guiding conservative treatment like NSAIDs, for strengthening, and gradual return to activity over 4-8 weeks for grades 1-2. pointers similarly respond to nonoperative care with added padding for protection, while disruptions require immediate pelvic stabilization via binders and multidisciplinary evaluation for associated visceral injuries before surgical fixation if diastasis exceeds 2.5 cm.

Hernias

A hernia in the groin region occurs when abdominal contents protrude through a in the , most commonly involving the or femoral areas. Inguinal hernias account for approximately 75% of all abdominal hernias, while femoral hernias represent about 3-5% of groin hernias but carry a higher risk of complications. These conditions primarily affect the structure, where the deep inguinal ring serves as the entry point for indirect types and Hesselbach's triangle for direct types. Inguinal hernias are classified into indirect and direct subtypes. Indirect inguinal hernias are congenital, arising from a patent processus vaginalis that allows protrusion through the deep inguinal ring, superolateral to the inferior epigastric vessels, and often following the inguinal canal into the scrotum. Direct inguinal hernias are acquired, resulting from weakness in the transversalis fascia within Hesselbach's triangle—bounded medially by the rectus sheath, laterally by the inferior epigastric vessels, and inferiorly by the inguinal ligament—and occur inferomedial to these vessels. Femoral hernias protrude below the inguinal ligament through the femoral canal, medial to the femoral vein and lateral to the lacunar ligament, and are more common in females due to wider pelvic anatomy. The of groin hernias involves a combination of increased intra-abdominal pressure and inherent or acquired weakness. Factors elevating pressure include , , heavy lifting, , and , which strain the over time. deficiencies may stem from congenital defects, aging, , or disorders like Ehlers-Danlos syndrome, predisposing the inguinal or femoral regions to herniation. Symptoms typically include a reducible bulge in the groin or that becomes more prominent with straining, coughing, or standing, accompanied by aching, burning, or heaviness in the area. Complications arise when the hernia contents—often bowel or omentum—become trapped, leading to incarceration, which causes severe pain, , and potential . Strangulation, a life-threatening , occurs if blood supply is compromised, resulting in tissue , fever, and a discolored, tender bulge; femoral hernias have a 15-20% strangulation risk compared to 2-3% for inguinal types. Surgical repair is the definitive treatment for symptomatic groin hernias to prevent complications, with options including herniorrhaphy and -based techniques. Herniorrhaphy involves suturing the defect without , such as the Shouldice repair, which reinforces the posterior inguinal wall through layered imbrication and achieves recurrence rates of 1-2% in specialized centers. repairs, like the tension-free Lichtenstein technique, overlay prosthetic material on the posterior wall to distribute tension, reducing recurrence to under 2% and suitable for both primary and recurrent cases. Laparoscopic approaches, including transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP) methods, place posteriorly via small incisions, offering faster recovery and recurrence rates of 0.1-3.6%, though they require general . For femoral hernias, repairs often use an inguinal or preperitoneal approach with reinforcement, yielding recurrence rates below 4%.

Infections and Inflammatory Conditions

The groin is susceptible to various infectious and inflammatory conditions due to its role in lymphatic drainage from the lower extremities, genitals, and perineum. Bacterial lymphadenitis, a common infection, arises when pathogens from lower limb wounds, skin infections, or sexually transmitted diseases ascend via afferent lymphatics to the inguinal lymph nodes, resulting in painful enlargement, erythema, and tenderness. Common causative agents include Staphylococcus aureus, Streptococcus species, and sexually transmitted pathogens such as Chlamydia trachomatis (in lymphogranuloma venereum), Treponema pallidum (in syphilis), and Haemophilus ducreyi (in chancroid), which can lead to suppurative nodes or buboes. In severe cases, untreated lymphadenitis may progress to abscess formation or systemic sepsis. Fournier's gangrene represents a life-threatening infectious , characterized by polymicrobial originating in the perineal, scrotal, or groin regions. Pathophysiologically, aerobic and anaerobic bacteria (e.g., , species) proliferate in compromised tissues, producing endotoxins that induce of subcutaneous vessels, ischemia, and rapid along fascial planes such as Colles' and Scarpa's . Risk factors include mellitus and , with the infection often spreading from urinary tract sources or perianal abscesses. Early signs include severe pain, , and skin discoloration in the groin, progressing to gangrenous changes if not addressed promptly. Non-infectious inflammatory conditions also prominently affect the groin. (HS) is a chronic, recurrent disorder involving gland-bearing areas like the inguinal folds and inner thighs, where follicular occlusion leads to keratin and bacterial debris rupture into the , eliciting a neutrophilic and lymphocytic that forms abscesses, sinus tracts, and fibrotic scarring. Symptoms manifest as painful, deep nodules (0.5–2 cm) with malodorous drainage, often exacerbated by friction or . , an immune-mediated spondyloarthropathy triggered by genitourinary infections (e.g., ), can involve the groin through associated , , or , causing localized pain, stiffness, and inflammatory swelling in the lower pelvic region. Symptoms typically emerge 1–4 weeks post-infection, with asymmetric potentially extending to nearby structures. Pathophysiologically, infectious processes in the groin often involve retrograde microbial migration through lymphatics, which drain the lower body to inguinal nodes, amplifying local immune activation with release and . In inflammatory disorders like HS and , dysregulated immune responses—driven by genetic predispositions (e.g., follicular occlusion in HS) or molecular mimicry (in )—perpetuate chronic tissue damage without direct pathogen persistence. Management of these conditions emphasizes prompt intervention to prevent complications. For bacterial lymphadenitis, empiric antibiotics (e.g., cephalexin or for staphylococcal infections) are initiated, with performed for fluctuant nodes; sexually transmitted causes require targeted therapy like for . demands immediate surgical debridement of necrotic tissue, often in multiple sessions, alongside broad-spectrum intravenous antibiotics (e.g., piperacillin-tazobactam plus clindamycin) and supportive care like fluid resuscitation. HS treatment tiers include topical clindamycin for mild cases, oral tetracyclines or biologics (e.g., ) for moderate disease, and wide excision with grafting for severe, refractory groin involvement. Reactive arthritis in the groin is managed with nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation, alongside treating the underlying if active. Overall, multidisciplinary approaches, including care and lifestyle modifications (e.g., for HS), improve outcomes.

Surgical Considerations

Surgical approaches to the groin region, particularly for , primarily involve open inguinal incision or minimally invasive laparoscopic techniques. The open approach utilizes a transverse incision parallel to the , allowing direct access to the for placement or tissue repair, such as in the Lichtenstein technique. This method is favored for its straightforward visualization and lower technical demands, though it may result in greater postoperative pain and longer recovery compared to laparoscopic options. Laparoscopic repairs, including transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) approaches, involve small abdominal incisions and to place a prosthetic over the myopectineal orifice. TAPP accesses the preperitoneal space through the , while TEP avoids intra-abdominal entry entirely, potentially reducing risks. Both laparoscopic methods demonstrate advantages in reduced chronic groin pain and faster return to normal activities, despite longer operative times. Critical anatomical landmarks guide these procedures to minimize morbidity. The , running along the , must be identified and preserved during to prevent injury, which can cause sensory disturbances or chronic . Similarly, the , branching from the internal iliac and supplying the testis, requires careful handling to avoid vascular compromise and subsequent ischemia or atrophy. These structures are approached via the in open surgery or the preperitoneal space in , with gentle retraction and electrocautery used judiciously near neural and vascular elements. Common complications of groin surgery include , known as post-herniorrhaphy , affecting up to 16% of patients due to or from or sutures. This , often involving the ilioinguinal or genitofemoral nerves, manifests as burning or tingling and may persist beyond three months postoperatively. Recurrence rates for mesh-based repairs vary from 0.8% to 14%, influenced by factors such as mesh type, surgical technique, and patient comorbidities, with laparoscopic approaches showing slightly higher rates in some cohorts but overall low reoperation needs. Preoperative plays a key role in planning groin surgery, especially for evaluation. serves as the initial modality for detecting inguinal hernias, offering high sensitivity (up to 97.5%) and specificity through dynamic assessment during to visualize defects and contents. For complex or occult cases, computed tomography (CT) provides detailed anatomical delineation, identifying multifocal defects or complications like incarceration, though it is reserved due to .

References

  1. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/groin
  2. https://www.ncbi.nlm.nih.gov/books/NBK470204/
  3. https://medlineplus.gov/ency/imagepages/20006.htm
  4. https://www.mayoclinic.org/symptoms/groin-pain/basics/causes/sym-20050652
  5. https://www.kenhub.com/en/library/anatomy/inguinal-region
  6. https://teachmeanatomy.info/abdomen/areas/inguinal-canal/
  7. https://embryology.med.unsw.edu.au/embryology/index.php/Testis_Development
  8. https://pmc.ncbi.nlm.nih.gov/articles/PMC9734211/
  9. https://www.sciencedirect.com/science/article/pii/S2059775423004911
  10. https://www.ncbi.nlm.nih.gov/books/NBK482246/
  11. https://emedicine.medscape.com/article/1923166-overview
  12. https://www.kenhub.com/en/library/anatomy/anterior-abdominal-wall
  13. https://www.ncbi.nlm.nih.gov/books/NBK557720/
  14. https://www.sciencedirect.com/topics/medicine-and-dentistry/superficial-inguinal-lymph-nodes
  15. https://dermnetnz.org/topics/skin-changes-at-puberty
  16. https://www.ncbi.nlm.nih.gov/books/NBK430733/
  17. https://pmc.ncbi.nlm.nih.gov/articles/PMC6529533/
  18. https://www.ncbi.nlm.nih.gov/books/NBK423/
  19. https://www.aafp.org/pubs/afp/issues/2020/1015/p487.html
  20. https://www.ncbi.nlm.nih.gov/books/NBK538262/
  21. https://www.ncbi.nlm.nih.gov/books/NBK27342/
  22. https://humananatomy.host.dartmouth.edu/BHA/public_html/part_5/chapter_25.html
  23. https://www.ncbi.nlm.nih.gov/books/NBK27332/
  24. https://www.ncbi.nlm.nih.gov/books/NBK554574/
  25. https://www.ncbi.nlm.nih.gov/books/NBK557639/
  26. https://www.cancer.gov/about-cancer/diagnosis-staging/staging/sentinel-node-biopsy-fact-sheet
  27. https://teachmeanatomy.info/lower-limb/nerves/lumbar-plexus/
  28. https://www.ncbi.nlm.nih.gov/books/NBK557605/
  29. https://pmc.ncbi.nlm.nih.gov/articles/PMC9009344/
  30. https://www.ncbi.nlm.nih.gov/books/NBK551640/
  31. https://teachmeanatomy.info/lower-limb/nerves/obturator-nerve/
  32. https://www.ncbi.nlm.nih.gov/books/NBK560504/
  33. https://www.physio-pedia.com/Ilioinguinal_Nerve
  34. https://www.sciencedirect.com/topics/veterinary-science-and-veterinary-medicine/ilioinguinal-nerve
  35. https://fpnotebook.com/Ortho/Neuro/IlngnlNrvCmprsn.htm
  36. https://www.kenhub.com/en/library/anatomy/inguinal-ligament
  37. https://www.ncbi.nlm.nih.gov/books/NBK534842/
  38. https://www.kenhub.com/en/library/anatomy/internal-abdominal-oblique-muscle
  39. https://www.kenhub.com/en/library/anatomy/transversus-abdominis-muscle
  40. https://www.ncbi.nlm.nih.gov/books/NBK549772/
  41. https://www.ncbi.nlm.nih.gov/books/NBK493166/
  42. https://pmc.ncbi.nlm.nih.gov/articles/PMC3063362/
  43. https://pmc.ncbi.nlm.nih.gov/articles/PMC10069335/
  44. https://www.ncbi.nlm.nih.gov/books/NBK542321/
  45. https://www.ncbi.nlm.nih.gov/books/NBK513247/
  46. https://www.ncbi.nlm.nih.gov/books/NBK537239/
  47. https://www.ncbi.nlm.nih.gov/books/NBK534256/
  48. https://my.clevelandclinic.org/health/body/23946-saphenous-vein
  49. https://cvphysiology.com/cardiac-function/cf018
  50. https://www.ncbi.nlm.nih.gov/books/NBK537248/
  51. https://www.orthobullets.com/knee-and-sports/3090/iliac-crest-contusion-hip-pointer
  52. https://emedicine.medscape.com/article/825869-overview
  53. https://radiopaedia.org/articles/pubic-symphysis?lang=us
  54. https://www.healthline.com/health/inner-thigh-pain
  55. https://www.mayoclinic.org/symptoms/groin-pain/basics/when-to-see-doctor/sym-20050652?p=1
  56. https://www.ncbi.nlm.nih.gov/books/NBK6888/
  57. https://emedicine.medscape.com/article/189563-overview
  58. https://www.ncbi.nlm.nih.gov/books/NBK459309/
  59. https://www.ncbi.nlm.nih.gov/books/NBK535449/
  60. https://www.mayoclinic.org/diseases-conditions/inguinal-hernia/symptoms-causes/syc-20351547
  61. https://www.niddk.nih.gov/health-information/digestive-diseases/inguinal-hernia
  62. https://www.nlm.nih.gov/medlineplus/ency/article/001301.htm
  63. https://www.ncbi.nlm.nih.gov/books/NBK549821/
  64. https://www.ncbi.nlm.nih.gov/books/NBK534867/
  65. https://www.mayoclinic.org/diseases-conditions/reactive-arthritis/symptoms-causes/syc-20354838
  66. https://pmc.ncbi.nlm.nih.gov/articles/PMC10711334/
  67. https://www.ncbi.nlm.nih.gov/books/NBK430826/
  68. https://pmc.ncbi.nlm.nih.gov/articles/PMC8845481/
  69. https://pmc.ncbi.nlm.nih.gov/articles/PMC2719730/
  70. https://pmc.ncbi.nlm.nih.gov/articles/PMC12295799/
  71. https://pmc.ncbi.nlm.nih.gov/articles/PMC7395915/
  72. https://pmc.ncbi.nlm.nih.gov/articles/PMC5896652/
  73. https://pmc.ncbi.nlm.nih.gov/articles/PMC5000866/
  74. https://pmc.ncbi.nlm.nih.gov/articles/PMC10234318/
  75. https://pubmed.ncbi.nlm.nih.gov/39670555/
  76. https://www.mayoclinic.org/diseases-conditions/inguinal-hernia/diagnosis-treatment/drc-20351553
Add your contribution
Related Hubs
Contribute something
User Avatar
No comments yet.