Wk 5, Case 5 - Review

Patient History: 40-yo male with right groin and lower abdominal pain after feeling a pop while playing softball.
Findings
SKELETAL: No bone contusion, macrofracture, or avulsion fracture.

PELVIS: No free fluid in the pelvis. No inguinal hernia. Symmetric sciatic nerves.

JOINTS: No internal derangement of either hip. No labral tear.

ACETABULUM/LABRUM: No labral tear; mild bilateral acetabular labral fraying. Normal acetabulum.

MUSCLES/TENDONS/LIGAMENTS: The adductor longus and rectus abdominus aponeurotic attachment to the right pubis is avulsed and retracted. Small fluid collection at the site of avulsion. Subjacent muscle strain. The aponeurosis is distracted by 9mm. There is a similar finding on the left though chronic without active swelling. The hamstrings are intact. Mild peritendinitis and tendinosis of the bilateral gluteus medius and minimus insertions without retracted tear. Normal iliopsoas tendons.

OTHER/SOFT TISSUE: Disc protrusion and annular disc tearing with facet arthrosis and mild stenosis at L4-5.

Conclusion
1. Sports hernia: Adductor longus and rectus abdominus aponeurotic attachment avulsion from the right pubis, without avulsion fracture. Slight distraction by 9 mm. Soft tissue swelling and surrounding muscle strain.
2. Similar chronic injury on the left, without swelling or avulsion fracture.