GROIN PAIN IN A RUNNER

Abstract

HISTORY - 18-year-old female presents with a 2-year history of left groin discomfort. She is able to recall “pulling” the groin at the time. This was followed by approximately 2 months of waxing and waning pain. She noted increased pain with standing. She had 12 weeks of physical therapy with no improvement in symptoms. Pain occurred with and without activity. She also experienced pain with weight bearing. She also noted low back pain, which occurred in association with the groin pain. PHYSICAL EXAMINATION - Functional range of motion was grossly intact for both lower limbs. Tenderness was palpable over the gracilis muscle insertion near the public bone. No obvious hernias were palpable. Internal rotation of the left hip passively increased discomfort. Muscle power was otherwise intact, except for pain limitations of the left lower limb. Sensation was intact and reflexes were 2+ bilaterally at L4, L5, and S1. Straight leg raising caused mild hamstring pain on the left. Reverse straight leg raising caused a mild ache in the area of the left groin. Pulses were 2+ in the BLE. DIFFERENTIAL DIAGNOSIS Chronic adductor muscle strain Avascular necrosis of the left hip Peripheral nerve entrapment i.e.: ilioinguinal nerve Osteitis Pubis Sports hernia Femoral hernia Inguinal hernia TESTS AND RESULTS X-rays left hip and pelvis - normal MRI - No osseous, articular cartilaginous or soft - tissue abnormalities are seen at the left hip. Triple Phase Bone Scan - normal EMG - normal lower extremity examination. Surgical consult - femoral hernia FINAL WORKING DIAGNOSIS Femoral hernia and Sports Hernia TREATMENT Surgical repair of the Femoral and Sports hernia. Physical therapy emphasizing both static and dynamic core stabilization activities, pelvic stabilization exercises, generalized lower extremity training, and proprioception training. Cleared to walk and run without limitation one-month post op.