Working Diagnosis:
Patient 1: Obturator externus strain with quadratus femoris and adductor minimis involvement.

Patient 2: Obturator internus strain with adductor magnus involvement.

Treatment:
Patient 1 and Patient 2 both responded well with conservative management consisting of modified training, PT and NSAIDs. Neither patient required surgery or immobilization.

Outcome:
Patient 1 returned to full unmodified activity in 6 weeks and continues to play professional soccer.

Patient 2 returned to full unmodified activity in 6 weeks and continues to play college football.

Author's Comments:
The obturator internus and obturator externus, along with the superior and inferior gemelli, the piriformis, and the quadratus femoris comprise the short lateral rotators of the thigh, which help with external rotation as well as abduction and adduction of the hip. Patients with an obturator internus or obturator externus injury often report a mechanism for injury involving kicking and the diagnosis is confirmed by magnetic resonance imaging. Most of these injuries do well with rest and rehabilitation and athletes typically return to full sport participation in 2-6 weeks. Athletes who perform repetitive kicks and have atraumatic hip pain should be evaluated for obturator muscle injury. Due to the obturator muscles having origin sites at the pelvis, the differential should include intra and extraarticular hip pathologies.

Editor's Comments:
The differential diagnoses for hip pain are extensive. Since the development of magnetic resonance imaging, there are diagnoses that can be made that were difficult to make previously. This has become important for specifically diagnosing the problem, and focusing rehab on the exact exercises that will be the most beneficial. When a patient with decreased hip internal rotation, with a positive log roll, and/or flexion adduction and internal rotation test that is positive; intraarticular pathology: labral tears, loose bodies, chondral damage, or avascular necrosis should be ruled out.

References:
Henrique Gonçalves Valente, Felipe Osório Marques, Luciano Da Silva De Souza, Roberto Trápaga Abib, Daniel Cury Ribeiro. Injury to the external obturator muscle in professional soccer athletes. Brazilian Journal of Sports Medicine. 2011; 17(1): 36-39.

Caoimhe Byrne, Abdullah Alkhayat, Pat O'Neill, Stephen Eustace, Eoin Kavanagh,
Obturator internus muscle strains. Radiology Case Reports. 2017;12(1): 130-132.

Lisa M. Tibor, Jon K. Sekiya. Differential Diagnosis of Pain Around the Hip Joint. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2008; 24(12): 1407-1421.

Return To The Case Studies List.