Thank you so much for the responses I have had to far.
In reply to some of the queries:

Yes, she had had an Xray of lumbar spine and hips and nil detected. didnt
include the pubic symphysis. Only upper part of femur was included. (Will
re-analyse these xrays) (so hopefully r/o the fibrous dysplasia Steve )
Julie: would you treat the pubic symphasis with muscle energy too?

Sandy: Thanks for the mm energy technique for slightly separately pubic sym.
will give it a go after reexam. Do I repeat this a couple of times, how long do
I hold the abduction and adduction contraction?

Re: the SIJ, saw no real indication to treat them initially from my assesment,
but will recheck.

Julie: Am not familiar the gillet test. please let me know.

She told me on initial assessment that doc said shes too young for a hernia (so
I didnt pursue it, but not sure if this is true). How else is this checked for?
She said no pain on cough or abdominal exertion.

Re: the ingulinal ligament: that area is tender generally, and yes int hat
region, but cant be sure if its inguinal lig.
Is there a way to check specifically for inguinal lig?


Barbra: not sure what anterior femoral glide syndrome is. Please fill me in.

Thomas test was negative, so I guess that may eliminate  ilopsoas (to an
extent). (but I must say tender to palpate in the region of iliopsoas), which I
am working on too.

Thanks again
Tambu


tmasaya wrote:
>
> 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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