Author: Kris Homb, MD
Co Author #1: Lawrence Frank, MD
Editor: Amy Valasek, MD, MS
A 27 year old otherwise healthy male professional soccer player presents with a seven month history of right lower abdominal and hip pain.
The patient’s symptoms developed gradually without a specific injury. He complained of intermittent aching and stabbing pain in his deep right lower abdomen and anterior hip aggravated by running for 30-60 minutes. His pain was non-radiating and an 8/10 on a numeric pain intensity scale. He denied numbness and tingling in his bilateral lower extremities. Previous treatments included rest, ice, stretching, and chiropractic care, all with temporary improvement. Prior to our visit, he was seen by a general surgeon who ruled out a recurrent hernia. His past medical history was significant for a right sports hernia repair and right knee arthroscopy, seven and five years ago, respectively.
Vitals signs were within normal limits. The patient was a well-developed and nourished male. Abdominal exam revealed a point of maximal tenderness deep to the proximal lateral edge of rectus abdominis muscle 3-4 inches superior to its pelvic insertion. There was no rebound tenderness, palpable masses, or abdominal wall defects. Lumbar spine exam revealed lower back pain with extension. Right hip exam revealed rectus femoris and iliopsoas contractures, but negative FABER, FADIR, and grind tests. Muscle strength testing was 5/5 throughout his bilateral lower extremities. Iliopsoas stretching and hip flexion muscle testing reproduced his pain.
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