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<v ->This is a 13 year old girl with groin pain,

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rule out sports hernia syndrome.

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She has pain, but not alteration of function.

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She's able to go out with discomfort

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but with the same level of performance

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and competence and do her cross-country running.

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So that should steer you in another direction.

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So as I'm going through this

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I'm thinking about all the potential causes

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of groin pain and both a man and a woman.

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I know what the lookalikes syndromes are.

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I've given you a list in other vignettes

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of what the differential diagnosis could be

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but I wanna list some real strong potential lookalikes

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and areas of search.

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One of the first things I try and do in my mind is decide

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do I have a bony problem

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in which the patients usually just complain of pain,

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but they're functional.

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And this was her.

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She had pain, but she's able to run

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and do all her all her stuff.

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So that doesn't fit with sports hernia syndrome.

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Those patients have trouble developing contraction,

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force and power.

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So what are some of the other big lookalikes?

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Well, baseball pitcher, hockey goalie syndrome

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where you're looking at the abductor muscles

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looking for prolapse of muscle through epimysium.

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She doesn't have that.

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Hockey player syndrome.

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Well, she's not a hockey player

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but just to mention, it's slapshot gut,

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usually injuries of the anterior abdominal wall

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in the region of the obliques.

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So you gotta be looking over here in the right setting

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probably not in this case

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but these are all parts of the search pattern.

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You're looking laterally at the obliques.

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You're looking at the spigelian line.

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You're looking at the linea alba.

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You're checking the iliacus,

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you're checking the iliopsoas.

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You're looking for hip flexor abnormalities and so on.

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So you're going out of the box.

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Then naturally,

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you're looking for the classic signs of sports hernia

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which are the cleft, which you've seen in other vignettes.

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Another very important lookalike is coxa saltans

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iliopsoas snapping tendon syndrome.

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And we'll have one of those vignettes in here

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where you'll see swelling

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of the hip flexor mechanism, the iliopsoas.

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You might see swelling around the tendon,

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not present here

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but you might go down and look around here.

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You'd like to have a PD spur or stir.

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This is a T2 not that sensitive,

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but she clearly didn't have that.

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And then you get into nerve entrapments

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something that most people don't think about.

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Opterator nerve ilioinguinal, neuralgia

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moralgia Parris Medica involvement

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of the lateral femoral cutaneous nerve

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and gender femoral nerve and trapping all lookalikes.

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And that's a story for another day.

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So now let's try and figure out what's wrong with her.

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We're scrolling up and down.

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We're looking really hard

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at the abductor take takeoffs at the interfaces.

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We're looking for clefts outside of the symphysis pubis.

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Don't see any, we're looking at the symmetry

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of the rectus abdominis down low, looks great.

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Linea alba looks great.

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Lateral margin of the rectus looks terrific

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but we do have osteoedema,

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real osteoedema on either side of the pubis.

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We also said 10 millimeters or greater of a white line

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through the pubis anteroposterior or top to bottom.

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Don't like it.

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So she's abusing her pubic synthesis

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from this long distance cross country running.

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And she's also got other areas of overuse syndrome.

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Look at her iliac crests.

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Both of them are hyperintense.

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That's abnormal even at a young person.

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So she's really just overdoing it.

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She's a skeletal abuser from cross country.

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She's got osteitis pubis or Athletic Pubalgia

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but without any of the soft tissue manifestations

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of sports hernia syndrome

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and now you can see why I would segregate these out.

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Treatment for this, rest.

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They get better.

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And when they come back, if they rest enough

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they're better sports hernia patients with clefts

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and separations and rectus tears, and a doctor tears.

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They feel better when they're resting.

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When they go back to play, the symptoms come right back.

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Let's move on, shall we.