Groin Pain- Basketball

Abstract

HISTORY: 14 year old female varsity basketball player presents with chronic left groin pain. She initially noted intermittent, mild pain approximately one year prior to presentation. Eight months ago, she developed worsening pain after sprinting drills in practice. She reports left groin pain with activity which persists in the evenings after practice. She denies pain at rest or with walking. Pain is not associated with radiation into the leg, paresthesias, buttock or back pain. Pain improves with naproxen, ice and rest. PHYSICAL EXAM: Weight 145lbs. Hip range of motion is full and symmetric with mild pain at end range of left internal rotation with 90 degrees of hip flexion. No pain with FABER, resisted hip flexion or adduction. Tenderness to palpation over left inferior pubic ramus. No tenderness along hip flexor or adductor musculature or along pubic symphysis. Normal neurologic exam and normal gait. DIFFERENTIAL DIAGNOSIS: Hip adductor/flexor strain Enthesitis/Apophysitis Pelvic (pubic ramus) fatigue or insufficiency fracture SCFE Avascular necrosis/Perthes disease Osteitis pubis L1-2 radiculopathy TESTS AND RESULTS: -AP Radiograph of pelvis: exuberant callous formation of inferior pubic ramus. -MRI of Pelvis (ordered after no change in plain films after 6 weeks of rest): exuberant callous formation about inferior pubic ramus fracture with visible hypodense linear fracture line; edema at fracture line on STIR images suggestive of healing; no other lesions identified. FINAL/WORKING DIAGNOSIS: Inferior pubic ramus stress fracture with exuberant callous formation TREATMENT AND OUTCOMES: 1. Crutch walking x 4 weeks. 2. Gradual return to activity, beginning with aerobic conditioning with deep water running and swimming. 3. Took the opportunity to discuss nutrition, energy balance, calcium and vitamin D recommendations. 4. Prior to return to play, patient underwent physical therapy including a core and pelvic stabilization program with jumping and landing drills. 5. Patient gradually returned to basketball 7 months after presentation and will follow up prior to beginning of the competitive season.