Obturator externus musculotendinous injury in a professional basketball player

Mr Régis COUDERTa, Dr Jean-Marie COUDREUSEb, Prof Thomas LE CORROLLERc, Prof Laurent BENSOUSSANa, Prof Pierre CHAMPSAURc, Prof Alain DELARQUEa, Prof Jean-Michel VITONa

a Département de Médecine Physique et de Réadaptation, Marseille, b Département de Médecine Physique et de Réadaptation, Service de Médecine du sport, Marseille, c Hôpital Sainte Marguerite, Service de radiologie, Marseille

INTRODUCTION:Acute muscle injuries in the lateral rotator group have been rarely described in the medical literature. The purpose of this study is to describe the diagnosis and treatment of an uncommon injury: obturator externus musculotendinous injury.

CASE PRESENTATION:A 30-year old male patient, professional basketball player, presented with right groin pain during a game, resulting from a controlled slide movement. Pain increased 1 hour after the game in the right groin and radiated to the buttock area. Examination finds no abnormalities during the specific testing of the adductor, hamstring or iliopsoas muscles, but the patient presents with diffuse pain during active hip mobilisation. Muscle testing in resisted external rotation reveals slight but existing specific pain. Slight pain and tenderness to palpation was also noted on the ischial tuberosity. Ultrasound examination and MRI revealed grade III distal obturator externus musculotendinous injury, combined with quadratus femoris muscle oedema. Our patient followed a functional treatment, combining rehabilitation (eccentric and proprioceptive exercises of pelvic and hip stabilising muscles), and reathletisation, which allowed him to return to professional competition 10 days after trauma.

DISCUSSION:In the medical literature, no international publication has ever reported this type of injury, due to its typical minor functional impact. This injury is caused by an eccentric contraction of the obturator externus. It seems to be under-diagnosed. Discomfort can be minor in daily life, due to muscular compensations, but it can be detrimental for elite athletes. Patients seem to recover rapidly, without an actual relation to the severe imaging findings. In addition, those muscles are not routinely assessed during ultrasound scan, and MRI is not often performed due to relative minor functional limitations. As a consequence, we insist on the need to perform a comprehensive clinical examination which will guide the ultrasound scan to the lateral rotator group of muscles. The ultrasound will confirm the need for hip MRI. Our clinical case shows that targeted rehabilitation will ensure a rapid return to competition without sequelae, and provide excellent functional performance, with a return to pre-injury level of sport.

Keywords : obturator externus muscle, acute groin pain, pelvic stabilization, ultrason, musculotendinous tear