The AAO Journal, 2014/06, 24(2):22, type of study: ,cr,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

Free full text   (https://www.academyofosteopathy.org/aaoj)

Keywords:

injury [113]
groin injury [1]
traumatic [55]
hip [394]
osteopathic manipulative treatment [3946]
OMT [3925]
case report [736]

Abstract:

History: A 15-year-old male patient with no significant history presented to an osteopathic manipulation clinic following an unrestrained motor vehicle accident in July 2012. He was discharged from the hospital with significant injuries and required crutches for weight-bearing secondary pain in the groin. The patient denied any weakness, numbness, tingling, bowel or bladder dysfunction. He was to start junior high school in the fall, and his football training was to resume in August. Physical Examination: Lumbar spine range of motion was 110 degrees flexion, 25 degrees extension with tenderness. Mild muscle spasm was noted over the L4-L5 on the right side. Straight leg raise testing was negative. Hip on right noted for swelling in groin region near the pubic symphysis and adductor insertion with tenderness to palpation. The patient had pain on internal rotation, adduction and flexion. Manual muscle testing of right hip adduction and flexion 4/5 was limited by pain. Gait was antalgic with bilateral crutches. Differential Diagnosis: Pubic shear, pubic bone fracture, adductor tear, rectus abdominus tear, and inguinal hernia were ruled out. Final Working Diagnosis: Pubic shear, right adductor, and obturator tear were diagnosed. Treatment and Outcomes: The patient was evaluated in the manipulation clinic and found to have somatic dysfunctions in the lumbar spine, pelvic, and pubic symphysis areas. Treatment consisted of manipulation, specifically a traction tug to the right pubic symphysis was performed, after which the patient reported greater than 70% reduction in symptoms and was able to ambulate without crutches. Physical therapy and acetaminophen as needed for pain were also initiated, as well as follow-up manipulation treatments. At the end of August, the patient was cleared by his orthopedic surgeon for progressive return to sports, and the patient reported minimal groin pain. Ureteral stump evaluation revealed realignment of the pubic symphysis.