Gradual onset, progressive groin pain in a marathon runner is concerning for a femoral neck stress fracture, which warrants further imaging such as an MRI or bone scan. Normal radiographs are common and do not preclude the presence of a stress fracture.
Treatment recommendations are based on the location and severity of the fracture. Compression-sided fractures are usually treated non-operatively, with protected weight-bearing until pain-free, and cessation of running until healed. Tension-sided fractures and fractures that involve more than 50% of the femoral neck are generally treated operatively with percutaneous screw placement. A careful evaluation of the training regimen, dietary history, and menstrual history should also be performed.
1. & 2. Corticosteroids are not used for treatment of stress fractures. An injection may be useful in the diagnosis and treatment of intra-articular pathology, such as a hip labral tear.
3. Hip and back pain can overlap and an EMG/NCV study can be used to evaluate for lumbar radiculopathy.
5. The clinical scenario is not typical of sports hernia and the use of imaging modalities to diagnose sports hernia remains controversial.
Shah A, Busconi B. Hip and pelvis. In: DeLee JC, Drez D, Miller MD, eds. Orthopaedic Sports Medicine. 3rd ed. Philadelphia, PA: Saunders-Elsevier; 2010:1451-1477.
Sekiya JK, Gibbs AE. Groin and pelvis injuries. In: Kibler WB, ed. Orthopaedic Knowledge Update: Sports Medicine 4. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2009:83-90.