Groin Injury - Running

Abstract

HISTORY: A 16-year-old male sustained a groin injury while running at full exertion. He heard and felt a 'pop' in his right groin and could not continue to run secondary to pain. The pain was described as 10 on a scale of 0 to 10 and located in the proximal inner thigh region. Flexion at the hip and adduction of the leg worsened the pain. The patient denied any associated low back or knee pain. The patient was seen in the ED the next day where X-rays were taken. The next evaluation was 1 week later in an outpatient orthopedic / sports medicine clinic. PHYSICAL EXAMINATION: Examination 1 week after the injury of the right hip revealed tenderness to palpation in the mid inner thigh. Active hip flexion was intact with moderate discomfort. Resisted hip flexion and adduction as well as passive hip extension and leg abduction reproduced pain. There was no significant ecchymosis or palpable defect at the area of injury. Active range of motion at the hip was decreased secondary to pain. The low back and knee exams were normal. DIFFERENTIAL DIAGNOSIS: Adductor injury Hip flexor injury Iliopsoas injury Apophyseal injury Apophyseal avulsion fracture Labral tear TEST AND RESULTS: Hip radiographs: _ 1 cm fragment avulsed from the lesser trochanter of the femur with 3 cm proximal retraction MRI of the right hip and pelvis: _ no injuries to tendons or ligaments of the region _ no other bony injuries other than avulsion FINAL/WORKING DIAGNOSIS: Avulsion fracture of the lesser trochanter of the femur TREATMENT AND OUTCOMES: 1. Weight bearing as tolerated with use of crutches as needed 2. Follow up at 3 weeks post injury revealed improvement in pain, range of motion, and strength 3. Follow up 6 weeks post injury planned with possible physical therapy prescription 4. Management ongoing