Acute Obturator Externus Injury in Professional Soccer Players: A Case Series

Abstract

When patients present with hip or groin pain, proximal quadriceps or adductor injuries are often initially suspected. In this case report, however, we present three cases of professional soccer players who were found to have obturator externus injury. A 30-year-old player and a 24-year-old player complained of pain in the left side after long distance shooting during an in-season training session and a match, respectively. Another 24-year-old player complained of pain in the right side after long distance passing during a preseason training session. On physical examination, active hip external rotation and passive hip internal rotation and extension elicited pain in all three players. All three players underwent magnetic resonance imaging (MRI) which found obturator externus grade II injuries for two players and grade I injury for one player. Rehabilitation protocols included relative rest, cryotherapy, and electrotherapy over a period of one week. All patients were able to return to play after 10 days. Correct identification of obturator externus injury afforded our players a favorable prognosis and a relatively quick return-to-sport compared with quadricep or adductor injury.

An Unlikely Cause of Groin Pain: Obturator Externus Tear in a Professional Soccer Player

“…Indeed, the most frequently described causes of groin pain are adductor-, iliopsoas-, and inguinal-related groin pain [ 2 ] However, injury to the external rotator muscles is also a cause of groin pain and should therefore be taken into account [ 1 , 6 ]. Several mechanisms of injury are described, but none very specific, and the most commonly described involve the movements that our athlete performed: rapid and unstable change of speed and load, associated with flexion and internal rotation.…”

“…Despite these characteristics, the clinical diagnosis remains a challenge, and ultrsound typically does not have sufficient resolution in depth for the correct diagnosis. Therefore, MRI is the gold standard, allowing assessment of the location and severity of the lesion [ 5 , 6 ]. The clinical presentation and physical examination are very unspecific, so the diagnosis is essentially a diagnosis of exclusion of the most common causes.…”

“…Nevertheless, isolated traumatic injury of the obturator externus muscle is rarely described with only a few case reports being described in the literature [ 3 , 5 ]. So far the case reports that described the injury raise the suspicion that there is a correlation with ball-kicking sports (after long-distance shooting or passing), such as soccer, rugby, and American football [ 3 , 6 ].…”

“…However, most patients present anterior hip pain. Clinical examination elicits pain associated with hip flexion and passive internal or external rotation against resistance, sometimes suggestive of intraarticular joint pathology [ 3 , 5 , 6 , 10 ].…”

“…The obturator externus originates from the external bony margin of the obturator foramen with a cylindrical tendon passing under the femoral neck and inserting in the trochanteric fossa [7,8], 25-38 mm distal to the piriformis fossa, with a completely different trajectory from the other external rotators [9]. The primary function of the obturator externus is to externally rotate the hip when in neutral position and flexed at 90 degrees, while the secondary action is to adduct the hip when in flexion and stabilize it [5][6][7]10].…”