Posterior Thigh Injury—Field Hockey

CASE HISTORY: A 25-year-old female field hockey player experienced acute left groin pain radiating to her thigh during a game, lasting only a few minutes. An initial evaluation by a general practitioner revealed no specific symptoms or clinical signs; the athlete was advised to rest and prescribed anti-inflammatory medication. PHYSICAL EXAM: During a subsequent training session, the patient reported pain extending to the posterior thigh. The clinical examination noted non-specific pain radiating from the groin to adjacent regions, with occasional lateral and posterior extension. DIFFERENTIAL DIAGNOSES: Piriformis syndrome; Nerve radiculopathy; Quadratus femoris tendinopathy; Labral tear TESTS & RESULTS: Initial X-rays showed no fractures or abnormalities. Given the patient’s age, a CT scan was considered, and an MRI (axial T2-weighted fat-suppressed images) confirmed a quadratus femoris muscle tear. Clinical tests (passive extension, adduction, and external rotation) indicated approximately 9.1% asymmetry. FINAL DIAGNOSIS: Quadratus femoris muscle tear. DISCUSSION: This case underscores the challenges in diagnosing soft tissue injuries that present with non-specific symptoms. Although initial imaging was unremarkable, advanced imaging with MRI was critical for confirming the diagnosis, thereby excluding other conditions such as piriformis syndrome and nerve radiculopathy. Early and accurate diagnosis is essential to guide appropriate treatment and prevent further complications. OUTCOME OF THE CASE: The patient was managed conservatively with rest, medications, and steroid injections, along with a physical therapy program emphasizing hip abductor strengthening. Adjunct therapies (e.g., ultrasound, shockwave, and electrical stimulation) were also considered. RETURN TO ACTIVITY AND FURTHER FOLLOW-UP: The athlete was advised to gradually resume activity under supervised rehabilitation once symptoms improved. Follow-up clinical evaluations and imaging studies are planned to monitor healing and determine readiness for full return to sport.