Unraveling Chronic Abdominal Pain In A Division I Volleyball Player

HISTORY: A highly active Division I volleyball player presented to the sports clinicwith chronic left lower quadrant abdominal pain near the pubic symphysis, persisting for one year. The pain was exacerbated by activity, stretching, andtwisting. Despite multiple rest periods as previously recommended by anorthopedic doctor, ice therapy, and structured rehabilitation, symptoms remained. PHYSICAL EXAM: No visible lesions or swelling; no localized bruise was noted. Tenderness waspresent over the left lower quadrant, with pain during abdominal flexion andleftward twisting. Range of motion remained intact. DIFFERENTIAL DIAGNOSIS: Left rectus abdominis strain• Rectus sheath hematoma• Intra-abdominal pathology (diverticulitis)• Sports hernia• Abdominal wall hernia IMAGING FINDINGS: CT abdomen/pelvis showed no acute inflammatory process, urinary tract calculi, orappendix abnormalities. MRI revealed a 1.2 × 1.6 × 3.3 cm ovoid fluid collectionwithin the lateral half of the distal left rectus abdominis, extending nearly the fullmuscle thickness, with proximal feathery edema-like signal spanning 4 cm. The rightrectus abdominis was normal. No stress reaction or fractures were noted. FINAL DIAGNOSIS: Left rectus abdominis muscle strain (Grade 3) with hematoma/seroma. TREATMENT & OUTCOMES: The patient consented to platelet-rich plasma (PRP) injection under real-timeultrasound guidance. Patient was advised to continue PT. Two months post-procedure, she demonstrated significant improvement, successfully toleratedrehabilitation, and returned to play without complications.