Groin Pain - Discus Thrower: 1178

HISTORY: A 24-year-old male discus thrower presents with severe left groin pain, accompanied by low abdominal pain of 5 month evolution. Groin pain increased in intensity over the 5 months of competitive season. He had to stop competing when the groin pain became unbearable. The athlete received physical therapy elsewhere for 3 weeks with no resolution or improvement of symptoms. He did not seek further medical attention until 4 months later, when he noticed that the pain had not subsided and he was about to begin the preseason training. Pain exacerbated with abduction and flexion of the hip and was unable to do sit-ups due to severe pain. PHYSICAL EXAMINATION: There was no edema or swelling on the left thigh, groin or abdominal area, there was an exquisite tenderness over the insertion of the left adductor, abdominal muscle, and over the symphysis pubis. There was severe pain with passive abduction of left thigh, active adduction, flexion, and internal rotation. He is unable to sit from supine due to pain in lower abdominal muscles, requiring him to roll and lift sideways. Sensation is intact to all modalities. Strength is intact in al muscles of lower extremity except, in left adductors, and Iliopsoas muscles where he gave way due to severe pain. DIFFERENTIAL DIAGNOSIS: Osteitis Pubis Adductor Tendinopathy and Abdominal Muscle Strain Pubic Stress Reaction Sports Hernia Avulsion Fracture at Adductor Insertion Pubic Stress Fracture TEST AND RESULTS: X Ray Pelvis AP - Mild irregularity is noted along the inferior aspect of the symphysis bilaterally. No significant subcortical bone sclerosis. Pelvic MRI - Increased signal intensity to the subcortical bone along the symphysis, more pronouncedon the left side. Minimal edema within the symphysis and extending into the insertion of the obturator and adductor muscles. Compatible with Osteitis Pubis. FINAL WORKING DIAGNOSIS: Osteitis Pubis TREATMENT AND OUTCOMES: Physical therapy elsewhere for 3 weeks Relative rest for 3 days. Fluoroscopy guided symphysis pubis injection of steroid and anesthetic. Patient had complete resolution of symptoms 4 days after injection Physical therapy - Range of motion, stretching of Adductors and Rectus Abdominis, strengthening of thigh muscles, and core strengthening program. Athlete will start sport specific training, throwing technique evaluation and throwing technique modification prior to returning to sport.