GROIN INJURIES

In severe cases aspiration of the bursa and injection of a local anaesthetic and corticosteroid is often very beneficial.

Trochanteric bursitis pain is often aggravated by the stretching of glu- teus medius, with the hip adducted and laterally rotated.

Rehabilitation: If injury is due to direct trauma then appropriate management as described above will be sufficient to set- tle the inflammation. As bursitis is more often secondary to a biomechanical abnormality, ie. excessive lateral tilt of the pelvis, then orthotic control of the lower limb is necessary. This must be accompanied by a rehabilitation pro- gramme which includes flexibility work for

Anatomical site Eponym Iliac crest

Femoral Head Vertebral body

Buchman Perthes Calve

Ischiopubic Oldberg/Van Neck junction

Symphysis pubis Pierson

Lower thoracic/ Scheurmann upper lumbar

Table 2: Common sites of adolescent injury in the spine, abdomen and pelvis

the gluteii and iliopsoas region and pelvic stability exercises to control lateral shift.

6. Adolescent groin pain The adolescent player is not within the remit of this paper however it should be considered that during this period of bone growth a number of sites can be affected by the strong pull of developing muscles and the forces they produce when a child has a growth spurt. They can also be affected by the stresses exerted by play- ing competitive sport. Length of bone and the soft-tissues may alter the leverage system of the surrounding joints produc- ing excessive loading at one end of the fulcrum point of movement. Three differ- ential diagnoses should be considered in the adolescent player:

1) Slipped capital femoral epiphysis - most common in boys between the ages of 12-15 and identifiable by a widening of the growth plate on x-ray

2) Apophyseal injury - the apophyses are sited at the attachment of the musculo- tendinous tissue to the bone and accom- modate longitudinal bone growth and associated lengthening of the muscle and tendon. Excessive traction forces pro- duced on activity often results in inflam- mation at this site, known as apophysitis

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3) Osteochondral injury - osteochondro- sis is a disease of the growth or ossifica- tion centres of the bone and is stimulated by trauma with most conditions being present in the spine or lower limb due to the stresses produced by weight bearing. Perthes disease is the most common osteochondral related injury in the ado- lescent groin and is common between the ages of 4-10.

References 1. Dostal WF, Soldberg GL, Andrews JG. Actions of hip muscles.

Physical Therapy

1986;66(3):351-361 2. Gamble JG, Simmons SC, Freedman M. The symphysis pubis: Anatomic and pathological considerations. Clinical Orthopaedics and Related Research 1986;203:261-272 3. See page 40

Other possible differential diagnoses for groin pain

● Sacro-iliac joint ● Lumbar spine ● Infection ● Obturator neuropathy ● Schwannoma, lumbar spine

Figure 6: Other possible groin pain diagnoses 32 SportEX

TIP