CASE 10 – GROIN PAINS

11 year old with right groin pain X 6 months

What’s the diagnosis?

11 year old active boy presents with a 6 month history of Right anterior groin pain.  It’s worse with sprinting, running, and jumping.  He plays soccer during the summer, and boxes and cycles during the winter.   He points to his right anterior groin as area of pain.

OE:
He is mildly overweight.
There is no gait abnormality.
No evidence of LLD
Hip joint exam – Hip flexion 135 deg bilaterally no pain, 45 deg ER , and 30 deg IR bilaterally without pain.  No pain with labral impingement tests. FADIR< FABER
Rectus femoris is 4/5 and painful v. resistance
Psoas is 4+/5 without very much pain
Sartorius 5/5 no pain

Imaging:  See above

A:    Right Anterior Inferior Iliac Spine Apophysitis

P:   Rest (no running, sprinting, jumping) X 6 weeks.  NSAIDs (ibuprofen 200mg po q8h prn pain).  I recommended crutches, not because of his gait, but as a reminder to himself not to run and other children to stay clear.  Follow up at 6 weeks – Right AIIS – nontender.  Patient able to resume activities without discomfort by 8 weeks post injury.

Dr. Neil Dilworth (Jan 8, 2015)