Stubborn Groin Pain In An Adolescent Soccer Player

HISTORY: A 17-year-old male soccer player presented to clinic with a chief complaint of right groin pain for 18 months. The pain was described as soreness that was worse with sprinting and lateral movements. There was no back pain, hip pain, clicking, popping, numbness, tingling, or radiation. The groin pain persisted despite rest, ice, anti-inflammatory drugs, physical therapy, and multiple chiropractor visits. PHYSICAL EXAMINATION: Bilateral hip exam revealed normal gait with no skin changes or inguinal masses. Tenderness on palpation was elicited over the proximal right hip adductor muscles. There was full passive and active range of motion of the hips with full strength, but active and resisted hip adduction was painful on the right. Adductor squeeze test was positive on the right. Sensation was intact. DIFFERENTIAL DIAGNOSIS: 1. Hip adductor strain. 2. Hip flexor strain. 3. Femoroacetabular impingement. 4. Femoral neck stress fracture. 5. Athletic pubalgia. TEST AND RESULTS: Bilateral hip x-rays: Unremarkable. No acute fracture or dislocation. FINAL WORKING DIAGNOSIS: Right hip adductor tendinopathy. TREATMENT AND OUTCOMES: 1. Dry needling of the right proximal hip adductor longus tendon was conducted once per week for a total of 3 sessions. 2. The patient underwent a regimen of static stretching for the hip adductors, abductors, flexors, and extensors, three times daily starting after the first dry needling session. 3. The patient was assigned concentric exercises for the bilateral hips starting 1 week after the last dry needling session, when he had full, painless range of motion, with a gradual increase in resistance. 4. Gradual return to soccer-specific activities was initiated when the patient had normal, symmetric strength, 8 weeks after the initial presentation. 5. The patient returned to full participation in soccer 12 weeks after the initial presentation.