Acute groin pain in a 10-year-old sprinter
- Correspondence to Dr Wojciech K Sawicki, Emergency Department, Countess of Chester Hospital, Liverpool Road, Chester CH2 1UL, UK;
- Accepted 18 September 2012
- Published Online First 17 October 2012
A 10-year-old girl presented to our department with pain in her right groin which had started suddenly as she was running a 100 m sprint, causing her to fall down to the ground. On examination, she was comfortable at rest, but experienced pain on internal and external rotation of her right hip, where she was also tender to palpation. Analgesia was administered and a plain radiograph taken. This showed an avulsion and superior displacement of her right lesser trochanteric apophysis (figure 1). She was referred to the orthopaedic team and was discharged with analgesia and crutches, with follow-up in the fracture clinic.
The iliopsoas attaches to the lesser trochanter and a forceful contraction of this muscle such as may occur during sprinting may cause an avulsion of the lesser trochanteric apophysis. This will result in groin pain and inability to raise the leg straight when the patient is sitting down with the knee extended (positive Ludloff's sign). Current recommendations are for conservative management1 with symptomatic treatment. There appears to be no correlation between the degree of displacement and the eventual outcome, which is generally good. One should note that an avulsion of the lesser trochanter in an adult is highly suggestive of metastatic bone disease.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; internally peer reviewed.