Cases of bursitis, nerve entrapment, and enthesopathy of the inguinal ligament will also generally respond to initial conservative measures as described for the adductor tendinopathy. We have found that cases of the iliopsoas bursitis tend to produce pain in the anterior groin more typically, and the inguinal ligament enthesopathy pain at the pelvic insertion. Entrapment of the iliopectineal nerve will often result in pain, which can radiate into the testicular region. Obturator neuropathy can present with decreased sensation in the obturator distribution as well as weakness of the adductor muscles. Electrodiagnostic testing may demonstrate changes in the adductor musculature.
Electrodiagnostic testing is also useful in ruling out lumbar referred pain.
For those cases that do not respond to conservative measures a steroid injection can be considered for treatment of the bursitis, nerve entrapment, or enthesopathy. The injection serves dual purposes, both diagnostic and hopefully therapeutic. Injections should be directed by the physical examination as noted above, although certain refractory cases may require a series of injections to best localize the particular pain generator. The pain progresses to involve the adductor longus tendon as well as the contralateral inguinal and adductor regions. The location of pain suggests injury to both the rectus abdominis and adductor longus muscles.