An Unforeseen Cause Of Lower Abdominal And Groin Pain In A Male Recreational Athlete - Page #1

Author: Ryan Sprouse, MD
Co Author #1: Wade M. Rankin, DO
Co Author #2: Royce D. Moore, MD
Co Author #3: Robert G. Hosey, MD

Patient Presentation:
A 32-year-old Caucasian male recreational athlete presented to clinic due to a four-month history of gradually worsening right sided lower abdominal pain and proximal groin pain.

The patient's pain was most specifically localized near the distal attachment of the rectus abdominis muscle and was reproduced with torso flexion, bilateral hip flexion, running, and when swinging a bat. The pain radiated to the right testicle. He had been trying over-the-counter NSAIDs and acetaminophen which helped slightly. He had no history of abdominal surgeries or injuries to the abdomen or groin. He had not noticed any masses and denied acute trauma, paresthesias, dysesthesias, lower extremity weakness, or changes to his bowel, bladder, or sexual function. The patient was active in playing softball and running approximately five miles daily.

Physical Exam:
Healthy appearing male in no acute distress. Abdominal examination revealed tenderness to palpation at the distal lateral rectus border. No masses palpated. There was no direct or indirect hernia detected; however, there was tenderness to palpation at the entry of the inguinal canal. Hip examination revealed full passive range of motion with hip flexion, extension, internal and external rotation, abduction, and adduction. He had pain localized to the distal attachment of the rectus abdominis with right hip flexion, internal rotation, adduction, and with torso flexion. He had no pain with FABER testing. Stinchfield test was negative. He was neurovascularly intact distally.

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