PELVIC INJURY - FOOTBALL

Abstract

803 HISTORY- 21y/o division three college football player sustained blunt force trauma to lumber region after being flipped onto back. Player had removed back plate prior to game. He continued to play until the end of the game and complained of no pain other than the initial blow. He then reported intense pain beginning 2 days post injury over the right PSIS and lower lumbar region which required ER evaluation and parenternal narcotics. Pain intensified over the next 2 days and began radiating down the right buttock and leg only to subside after seven days of treatment. At day nine pain returned to the same region with the previous intensity. Patient was admitted to the hospital for further observation. PHYSICAL EXAMINATION-Team orthopedist evaluation on the field revealed no abnormalities or deformities. Re-evaluation 2 days later revealed severe point tenderness on the right PSIS, lateral gluteus and paraspinous muscles. AROM was unattainable and PROM, proved too painful for measurement specifically flexion and extension of the right hip. Neurologic exam was negative and intact. A second evaluation 13 days later revealed the same intense point tenderness over the PSIS and lateral gluteus as well as radiating pain. DIFFERENTIAL DIAGNOSIS Posterior Superior Iliac Spine Fracture Herniated Lumbar Disc Acute rupture of Psoas Muscle Acute Iliopsoas Hematoma TEST AND RESULTS Plain X-Ray-normal Three Phase Bone Scan-negative Spect Scan Bone Scan-negative Pelvic MRI without Contrast- elliptical shaped right psoas hematoma extending into right iliopsoas impinging on lower pole of right kidney. Pelvic and Body CT with Contrast-Right iliopsoas hematoma with possible infection as well as right paraspinous hematoma. FINAL/WORKING DIAGNOSIS Acute Psoas and Paraspinous Hematoma TREATMENT-Patient was admitted to the hospital after second recurrence of pain for 24 hour observation and treatment. He was placed in traction and on a morphine pump with parenteral Toradol, Valium and IV antibiotics. He was able to begin ambulation with a walker nine days after admittance. Patient resumed activity approximately three months later with no recurring problems.