Groin Injury- Swimming

Abstract

HISTORY: A 20 year old Division 1 varsity swimmer who specializes in breast stroke presented for evaluation of worsening right groin pain over the past several months. Her pain was worse with breast stroke kick and increased intensity of training. The pain was located in right proximal adductor area. Her pain had continued despite working with a physical therapist and relative rest for at least 3 months. X-ray and MRI of pelvis including athletic pubalgia protocol was negative for any pathology. She denied any weakness or numbness/tingling. PHYSICAL EXAMINATION: Examination of her right leg revealed focal tenderness to palpation of proximal adductor tendon attachment on pubic symphysis without any swelling or deformity. She had pain with resisted adduction in all planes and resisted abdominal crunch. Active straight leg raise, pubic symphysis spring test were positive. Negative FADIR and log roll. DIFFERENTIAL DIAGNOSIS: 1. Adductor strain 2. Adductor tendinopathy not seen on MRI 3. Athletic pubalgia 4. Osteitis pubis 5. Pelvic Floor dysfunction 6. Pubic rami stress fracture TEST AND RESULTS: MRI pelvis: - rectus abdominis insertion and right adductor tendon origin is normal in signal intensity and morphology. - No evidence of osteitis pubis. Ultrasound: - thickening of right adductor tendon with evidence of enthesopathy and calcifications worse on the right. - No evidence of osteitis pubis FINAL/WORKING DIAGNOSIS: Right adductor tendinopathy TREATMENT AND OUTCOMES: 1. Underwent PRP injection of right adductor tendon 2. Was non weight-bearing for 1 week post-injection 3. Progressed to full weight bearing and light exercise (swimming with just arms), 1-6 weeks post-injection 4. Began eccentric exercises, 7 weeks post injection 5. Ultrasound showed full tendon healing, cleared to return to full swimming and lifting, 12 weeks post injection