Groin Injury- Football

Abstract

HISTORY: A 22 year old division III college football player was running during practice and tried to make a cut on 8/22/17 and felt a pull in his left groin. The patient was evaluated by the athletic trainer and was diagnosed with adductor strain. He met with the athletic trainer frequently over the next few weeks to treat his pain with modalities such as laser therapy, electrical stimulation and cupping as well as doing strengthening exercises and activity modification. During game on 9/9/17, athlete played most of the game but had great amount of pain. He woke up the morning of 9/11 and noticed that he was severely bruised at the left groin region and was unable to walk without discomfort. The athlete said that he felt pain radiating into his abdomen and down into his left leg. At that point, he was referred to our Sports Medicine clinic. PHYSICAL EXAMINATION: General: under no acute distress; alert and oriented Heart: regular rate and intact distal pulses; Lungs: CTA bilaterally; Abdomen: soft, mildly tender at right and left lower quadrants, non-distended, normal bowel sounds in all four quadrants; Groin- diffuse ecchymosis at left groin region & at pubic symphysis and left pubic tubercle; tender to palpation at left side of pubic region as well as at left lower quadrant of abdomen; weak left hip adductors & hip flexors noted on exam and pain with hip adduction and hip flexion DIFFERENTIAL DIAGNOSIS: 1. Left hip Adductor strain 2. Left hip Adductor tear 3. Left pubic tubercle bone contusion 4. Left Iliopsoas strain TEST AND RESULTS: Left Hip X-ray AP and Lateral: no acute fracture or abnormal findings MRI of Pelvis w/o contrast: left adductor longus tear with 2.5cm of retraction FINAL WORKING DIAGNOSIS: Left adductor tendon avulsion with approximately 2.5 cm of tendon retraction. TREATMENT AND OUTCOMES: The athlete had approximately two weeks of rest after time of diagnosis. The consulting orthopedic surgeon recommended conservative treatment with activity modification and rehab exercises as he was desiring to finish his senior season. He continue to report pain with activity and at the conclusion of the season, will likely be reimaged to determine if conservative treatment is still acceptable or if injury has worsened further to the point of requiring surgery.