Author: Altamash Raja, DO, CSCS
Co Author #2: Makenzie Worthington, PT, DPT
Co Author #3: Soo Yeon Kim, MD
Senior Editor: Kristine Karlson, MD, FAMSSM
Editor: Drew Duerson, MD

Patient Presentation:
A 29-year-old female presented with three weeks of left lower buttock, perineum, and groin pain after a weightlifting injury.

History:
While performing a full snatch, she felt a sudden sharp pain in the left pelvic floor region. Her pain was a constant 4/10, located just lateral to the perineum, and worsened to 9/10 with activity. Two sessions of pelvic floor rehab provided mild reduction in pain. Subsequently, her pain spread to the left groin/perineal area, radiating to the medial thigh. Pain characteristic changed to deep, dull, pressure-like in the lower buttock, paresthesias in the left perineum, and lightning/shooting in the medial thigh with numbness and tingling. Alleviating factors included the prone position and non-steroidal anti-inflammatory medications. Provocative factors included any activity, especially sitting and bowel movements. Her pain interfered with sleep and activities of daily living. Gynecological causes of pain were ruled out.

Physical Exam:
GENERAL: Well-developed female, who appeared to be in no acute distress.
SKIN: Mild erythema and swelling noted on inspection.
MUSUCLOSKELETAL: There was a palpable, erythematous, tender mass over the left puborectalis/pubococcygeus region suspicious for hematoma. Tenderness was elicited in the left lower buttock, left ischial tuberosity, and coccyx. Dysesthesias were noted in the left pudendal nerve distribution. The range of motion of the left hip was within normal limits, with the exception of left hamstring tightness and deep hip external rotators range of motion was reduced relative to the right. Strength was 5/5 in bilateral upper and lower extremity key muscles. The athlete had a normal reciprocal gait without a noticeable limp.

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