Persistent Groin Pain In A High School Baseball Player With Hemophilia A

HISTORY: A 15-year-old high school baseball player has persistent groin pain for the past few years. He plays club baseball, thus has year-long activity, but states the pain is worse after baseball season in the spring and improves with rest over the summer. The pain is located on the anterior mid-groin region and is exacerbated by explosive hip flexion movements such as running. He denies any numbness, tingling, weakness, or pain radiation down his legs. During these episodes he receives a antihemophilic factor infusion and he feels better. The latest episode and infusion did not provide much relief thus he was referred to the sports medicine clinic for further evaluation. PHYSICAL EXAMINATION: Clinic examination shows no skin bruising, discoloration, or swelling. There was tenderness to palpation on the right groin anteromedial region. There was moderate pain with active and passive hip flexion, adduction, internal rotation and with resisted hip flexion. Otherwise, he had normal strength of his lower extremities and normal range of motion with no pain on external rotation and abduction. DIFFERENTIAL DIAGNOSIS: 1. Athletic pubalgia 2. Right hip or femur fracture 3. Inguinal hernia 4. Hematoma TEST AND RESULTS: MRI of the right hip: — Findings consistent with a resolving subperiosteal hematoma of the right iliac wing deep to the right iliacus muscle.— Healing right anterior inferior iliac spine avulsion fracture — Mild right pectineus and obturator externus muscle strains. FINAL WORKING DIAGNOSIS: Hematoma of the iliac wing and right anterior inferior iliac spine avulsion fracture. TREATMENT AND OUTCOMES: 1. Complete rest from sports activities for 4 weeks. 2. Light jogging, stationary biking, and isometric lower extremity exercises began 4 weeks post injury. 3. Return to running and with gradual progression to range of motion and strengthening exercises in week 5-6. 4. Gradual return to sport with increasing activity and sport specific training 6 weeks post injury. 5. Returned to sports 3 months post injury when he had full, painless ROM, normal strength and able to meet the demands of his sport. 6. Continue Hemophilia A treatment regimen based on recommendations by Hematologist. Worked very closely with Heme-Onc team at the OHSU Hematology Treatment Center for return to activity plan. 7. Repeat MRI if symptoms recur.