Long-standing groin pain in an elite athlete: usefulness of ultrasound in differential diagnosis and patient education – a case report

Abstract

Purpose: The purpose of this case report is to describe the diagnosis, treatment and outcomes of an athlete with long-standing groin pain. This aims to highlight the use of diagnostic ultrasound as an adjunct to physical assessment, differential diagnosis and patient education.

Materials and methods: An athlete presented a groin pain with 6 months of onset, who was refractory to conservative treatment. A systematic assessment approach and ultrasound scanning in static and dynamic positions led to the diagnosis of mild tendinitis of the conjoint tendon, adductor-related groin pain and obturator nerve entrapment. Conservative management using symptom-specific treatment was implemented. Pain levels during rest, running, forward lunge and palpation were measured using Visual Analogue Scale (VAS) each session. General health status was measured using EuroQol five dimensions questionnaire (EQ-5D). Maximum match time that the patient could play pain-free was also monitored.

Results: A reduction in pain, demonstrating a reduction in VAS scores during running from 8/10 to 0/10, forward lunge from 4/10 to 0/10 and palpation from 5/10 to 0/10; improved pain-free playing duration; and improved general health status with improved EQ-5D scores were achieved. The patient was able to return to playing professional level pain-free after 3 weeks of therapy.

Conclusion: The study demonstrates the usefulness of sonographic findings in differential diagnosis, patient education and treatment rationale. This case report suggests further investigation of the role of ultrasound imaging in groin pain, which may enable clinicians to apply differential diagnosis effectively. Clinicians who have access to diagnostic ultrasound or the skills to use ultrasound integrated into their clinical practice may have better treatment outcomes.

Keywords:

• Athletic pubalgia
• sports hernia
• groin pain
• osteitis pubis
• pubic symphysis dysfunction
• ultrasound
• diagnosis

Disclosure statement

No potential conflict of interest was reported by the authors.