Groin Pain - Wrestler

Abstract

0748 HISTORY: A 22-year-old male wrestler presented with intense groin pain during weightlifting. He had intermittent right groin pain since the incident. He had groin pain with lower extremity push off and prolonged sitting. He complained of a catching sensation and impending give-way of the right lower extremity. He denied locking of the hip. He was unable to complete the wrestling season. PHYSICAL EXAM: Examination revealed a 22 year-old male with a normal gait pattern. Pain on palpation of the right groin with no masses palpated. Muscle strength testing for hip flexion, knee extension, ankle dorsiflexion was 5/5. Muscle stretch reflexes showed 2+ Achilles and patella. Passive range of motion of the hip: flexion 105o, internal rotation 10 o, external rotation 30 o, abduction 30 o, adduction 20 o. Pain was reproduced with end range flexion, abduction, and FABER. Groin Pain – Wrestler C. Fotopoulos, H. Prather, Washington University, St. Louis, Mo Email: [email protected] DIFFERENTAIL DIAGNOSIS: Hip Labral Tear Hip Impingement Syndrome Hip Osteoarthritis Pubic Symphysitis Pubic/Hip Fracture Adductor Strain TEST AND RESULTS: Plain radiographs: – No major deformity, noted poor offset at the femoral head/neck junction with a prominence at the anterolateral head/neck junction. MR ARTHROGRAM: – Hip Labrum Tear FINAL WORKING DIAGNOSIS: Left hip anterior/superior labrum tear Femoral Head/Neck offset mismatch TREATMENT AND OUTCOMES: Physical Therapy: Focus: Lengthen Iliopsoas/Hamstring/Hip external rotators Strengthen: Abdominals, Gluteals, Hamstrings Ice/Heat to assist with ROMHEPContinued with moderate pain, ambulation to 6 blocks and pain with sitting. Left hip arthroscopy with open debridement with the following post-operative precautions: Toe-touch weight bearing for 6 weeks with crutches. AAROM in all planes within comfort zone. 3 ½ months post surgery he had no siting or ambulation restrictions. Hip range of motion showed internal rotation 15, external rotation 40, abduction 40, and adduction of 15 degrees. Advanced ROM as pain allows, advance core strengthening in three planes, begin simulation of sports specific activities. 10 months after his initial evaluation and 6 months after surgery, JB had just attained the number one position on the wrestling team and is preparing to defend his reputation as a two-time state wrestling champion.