Right Groin Pain Work-Up

Initial Imaging

Plain radiographs (AP pelvis and lateral hip) are the essential first-line imaging study for right groin pain, as they can identify hip osteoarthritis, fractures, and other bony pathology that commonly present with groin pain, according to the American Academy of Orthopaedic Surgeons 1, 2.
CT abdomen and pelvis should be obtained if the clinical presentation suggests non-musculoskeletal pathology, as it has excellent diagnostic yield for identifying alternative diagnoses beyond appendicitis in right-sided abdominal/groin pain, as recommended by the American College of Radiology 3.
MRI of the hip is indicated when initial radiographs are negative but clinical suspicion for hip pathology remains high, particularly for occult fractures, labral tears, or early avascular necrosis, according to the American Academy of Orthopaedic Surgeons 4.

Internal rotation of the hip that reproduces groin pain strongly suggests intra-articular hip pathology, according to the American Academy of Orthopaedic Surgeons 1, 2.
Hip internal rotation test: Pain with internal rotation indicates hip joint pathology (osteoarthritis, labral tears, or femoral neck fractures), as recommended by the American Academy of Orthopaedic Surgeons 1, 2.
Gait assessment: Antalgic gait with assistive device use suggests significant hip pathology, according to the American Academy of Orthopaedic Surgeons 1, 2.

Laboratory tests are not routinely necessary for isolated groin pain unless systemic illness, infection, or inflammatory conditions are suspected, as stated by the American College of Radiology 3.
Complete blood count: To assess for leukocytosis suggesting infection or inflammatory process, as recommended by Praxis Medical Insights 5.
Inflammatory markers (ESR, CRP): If osteomyelitis, septic arthritis, or inflammatory arthropathy is suspected, as recommended by Praxis Medical Insights 5.
Pregnancy test: Mandatory for all women of reproductive age to exclude ectopic pregnancy, as recommended by Praxis Medical Insights 5.

Hip osteoarthritis (most common in older adults): Groin pain with internal rotation, activity-related pain, radiographic joint space narrowing, according to the American Academy of Orthopaedic Surgeons 1, 2.
Occult hip fracture: Acute onset after fall, pain with weight-bearing, negative initial radiographs require MRI, as recommended by the American Academy of Orthopaedic Surgeons 4.

Failing to obtain radiographs first: Plain films must be obtained before advanced imaging, as they identify most significant hip pathology and guide further work-up, according to the American Academy of Orthopaedic Surgeons 1, 2, 4.
Missing occult fractures: If radiographs are negative but clinical suspicion remains high (especially post-fall with persistent pain), MRI is mandatory within 48-72 hours, as recommended by the American Academy of Orthopaedic Surgeons 4.
Neglecting pregnancy testing: Always obtain pregnancy test in women of reproductive age before imaging or treatment, as recommended by Praxis Medical Insights 5.