Abstract
HISTORY - A 21 year old college football player presents with increasing lower abdominal, right groin, and scrotal pain for 1 ½ years duration. He notes no initial trauma or sentinel event for the pain. Over the course of the next several months, the pain steadily increases and became more localized to his right hip/groin area. Patient noticed that the pain was exacerbated by running and sexual activity and radiated all over his pelvis and lower abdomen. PHYSICAL EXAMINATION: Examination revealed a soft, non-tender and non-distended abdomen without visible hernias, palpable masses, or hepatosplenomegaly. The musculoskeletal exam revealed no asymmetry and full flexion and extension of hips. However, decreased adduction and external rotation of the right hip with a negative Patricks test noted. Pt also had pain to palpation over pubic symphysis. Genital exam revealed normal genitalia, without hernia, testicular mass, lesion, or discharge. DIFFERENTIAL DIAGNOSIS Sports Hernia Varicocele/Hydrocele of Testis Sexually Transmitted Infection with Prostatitis/Epididymitis Labral tear of the hip Osteitis Pubis TEST AND RESULTS -U/S of groin/testes - revealed no visible hernias, nephrolithiasis, testicular or appendiceal torsion, varicocele, hydrocele, or mass of testis; however did show right spermatic cord swelling. -MRI Pelvis with and without contrast - 22mm right paralabral cyst and right superior labral tear. No hernia noted. -STI testing performed for Gonorrhea, Chlamydia, Syphilis, HIV, and Hepatitis panel negative on two separate occasions spaced out by 8 months in duration. FINAL/WORKING DIAGNOSIS - Right Labral cyst and Right acetabular labral tear. - Spermatic Cord Swelling. TREATMENT AND OUTCOMES -A series of steroid injections into the right hip using CT guidance to bridge to future hip arthroscopy for labral tear/cyst removal after football season has been completed. -Continue to be followed by athletic trainer for muscle strengthening exercises and stretches. -Scrotal support for spermatic cord swelling. -Returned to full workout routine and collegiate football within 4 weeks of steroid injection, muscle strengthening and stretching with full, painless range of motion, and able to meet the demands of his sport.
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