Did I Miss Something in Your narrative...has she been checked for a hernia ?
Sandy
William S. Quillen,PhD,PT,SCS
Associate Professor & Director
Physical Therapy Program
Indiana University School of Medicine
Coleman Hall 120
1140 West Michigan Street
Indianapolis, IN 46202-5119
317-278-1851
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-----Original Message-----
From: tmasaya [mailto:[log in to unmask]]
Sent: Monday, October 11, 1999 1:44 PM
To: [log in to unmask]
Subject: groin pain
Please help with the following case, Im a bit stuck.
A 15 year old female presents with R groin pain.
present hx- sharp pain acute in groin only, p felt walking and lifting leg
(eg
getting into car),
No other areas of tenderness or pain in leg
prior hx- pain began late last year gradual onset no specific incident
recalled. Has had on and off since then. Feel "clicking like" sensation in
groin
then pain begins and last several days (not actual click though). Now
episodes
occurring more frequently. occasionally gets so bad, she has to drag the leg
Occasionally Thoracic pain, but apparently not related
Meds: antiinflammatories help but pain always comes back.
o/e hip flexion p at 90 degrees (this is worst direction of movement), hip
abduction (with straight leg) tight, some discomfort.
Standing R SIJ level higher than L but subtle difference, knee creases
uneven,
R higher: probably leg length discrepancy but not hugh. Mild scoliosis in
stand
(concave in mid Tx region (very subtle again)
swimmer x3 per week and gala weekend (not highly competative): worse during
and
after swimming.
Lumbar mvts: p end of range extension and stiff.
palpation only L5/4 tender PA
SLR reduced on R and reproduces groin pain
hip accessory movements -nil detected
Palpation: "stringy like" texture of groin mm (definitely different texture
from other side) and very tender to palpate (medial to fem artery and one
quarter way down thigh medially)
good general health
physio Rx:
mobs PA Lx (made little immediate difference to SLR), then tried PA mabs in
L
side flexion (again little difference to SLR)- grade 3 mobs
soft tissue mass tender mm
hip mobs (simple Flexion)- no difference to hip Flexion
home programme of stretch all muscles surrounding hip (bilateral because
generally tight even on good side)
ultrasound over groin mm
advised cease swimming
My conclusion is appears to be adverse neural tension related, perhaps
aggravated by leg length discrepancy, but not responding to my treatment
Now had 5 treatments and not much change with these treatments. Wondering if
she is just too acutely inflamed at the moment and needs antiinflams again
to
settle and then physio while on antiinflamatories or after course of
antiinflams.
Am I missing something here?
Other techniques?
Do I suggest heel raise for such subtle difference?
??suggest MRI-could there be something else (these are very expensive
here-orthos very reluctant to do)
Thanks
Tambu
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