Groin pain in sportsmen is not always musculotendinous in origin.

CASE REPORT A 21 year old rugby player presented with bilateral suprapubic tenderness of 10 days duration. It was first noticed after a training session, and despite analgesics and rest had not settled. The term “suprapubic” in this case refers to the region just superior to the pubic symphysis and including the origin of the adductor longus bilaterally. The patient had suffered a similar episode six months previously when he slipped on some wet grass and hyperabducted both hips. He was seen at a private rehabilitation centre where he was diagnosed with a muscular haematoma secondary to trauma. He then had aggressive physiotherapy. Unfortunately, his pain did not improve and he continued to complain of severe suprapubic tenderness, even on minimal exertion. He presented to the accident and emergency department of his local hospital with these symptoms some days after the initial injury. A thorough examination was performed by a casualty officer, followed by a plain anteroposterior radiograph of his hips. This showed no bony injury and therefore the patient was prescribed analgesics and given bilateral injections of DepoMarcaine into both groins at the insertion of the adductors—that is, the pubic tubercle—as his pain was localised to this area. He obtained relief from the injected steroid preparation and returned to his usual daily activities within a few days. He presented to the same hospital six months later with an acute onset of localised tenderness at the origins of the adductor longus bilaterally. Movement of the left hip was restricted, especially at the extremes of abduction and external rotation, and he found difficulty in weight bearing. He was apyrexial at the time of admission and all initial blood results were normal. The next day, however, the patient developed a pyrexia of 38.5°C. His erythrocyte sedimentation rate was 75 mm/hour in the first hour (normal range for men: 1–13 mm/hour), and his C reactive protein level was 229 mg/l (normal range: <10 mg/l). Mid stream urine samples showed 68 white blood cells, 50–100 red blood cells, and some mixed contaminants. Blood cultures showed a heavy growth of Staphylococcus aureus sensitive to flucloxacillin. He responded well to intravenous antibiotics and his symptoms settled.