A 32-year-old professional ballerina presented with groin pain following the execution of a “grand jeté” during warm-up.
The patient suffered pain during walking and extension movements in the hip joint, which made dancing almost impossible for her. The pain also radiated to the distal region of the adductor muscle group.
A previous injury on the contralateral hip joint gave us the opportunity to compare the MRI images in 3 different situations: previous to injury (Figures 1a and 1b), shortly after injury (Figures 2a and 2b), and after absolving therapy (Figure 3). To provide an accurate comparison, axial T2-weighted fat-suppressed MR images were used.
The ultrasound, which was performed right away at the doctor's office, showed a muscle tear of the deep layer of the adductor group at insertion at the pubic bone as well as a muscle tear 10cm distal to the symphysis and a haematoma.
Background
The groin region constitutes an anatomical area subjected to substantial stress in ballet and other disciplines of dancing sports. Nevertheless, injuries in this area are often trivialised in comparison to more seemingly prevalent foot and ankle injuries in this sport [1].
Concerning our report's main topic, the rupture of the external obturator muscle, it must be said that also nearly all of the few reported cases, which can be found, mainly comprised male patients, who principally participated in ball sports [2–4].
The main reason for muscular injuries to occur in the groin region is trying to overcome a limited range of motion. In order to achieve that last range, a throwing movement at the end of a motion is often recognised, which may lead to an uncontrolled, rather unstable movement of the hip joint. With the purpose of maintaining stability in situations where the adductor muscles are not able to fully provide it, external rotators may also be harmed, which is also the case in injuries regarding the external obturator muscle [5].
The conduction of this muscle being located dorsal to the axis of rotation also explaining its function as an external rotator, being harmed in stressful situations as described previously [7,8].
Clinical Perspective
The patient suffered pain during walking and extension movements in the hip joint, which made dancing almost impossible for her. During clinical examination she showed pain caused by palpation located at the pubic bone and symphysis in the area of the adductor muscles' insertion.
The patient was sent to an MRI scan afterwards. Magnetic Resonance Imaging emerges as the preferred diagnostic modality for detecting tears in the external obturator muscle due to its capability to provide high-quality visualisation of deep soft tissue structures [3,6].
Imaging Perspective
Eventually, the final diagnosis is made by a deduced decision regarding the injured muscle from the examined clinical status and MRI imaging findings. As seen, both clinical examination and symptomatic portrait are as important as the imaging part to decide about taking further action, as it happened.
Outcome
The patient received conservative treatment, including physiotherapy and a suggested careful approach to dancing sports during this period of time. This resulted in a marked improvement observed in the MRI (Figure 3), accompanied by a noteworthy change in her then-presented current clinical condition.
Take Home Message / Teaching Points
This case report highlights the importance of recognising and addressing rather rare groin injuries in ballet, thereby aiding in improved diagnosis and treatment strategies.
All patient data have been completely anonymised throughout the entire manuscript and related files.
Isolated partial rupture of the left external obturator muscle
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According to the provided pelvic MRI images, an abnormal signal is observed in the deep soft tissue of the right groin region, mainly concentrated around the area near the external obturator muscle. In T2-weighted sequences, there is a localized high signal at the muscle’s origin, insertion, and belly, suggesting muscle fiber tearing or edema. Mild swelling is noted in the surrounding soft tissue, and there is no obvious large-scale fascial tear. No apparent fracture or avulsion deformity is seen in the adjacent bony structures (pubis, ischium, and ilium).
Considering the patient’s age (32 years old, professional ballet dancer), the acute injury mechanism (sudden pulling pain in the groin region during a “grand jeté”), the clinical presentation (notable pain during hip extension and walking), and the MRI findings (localized abnormal signal of the external obturator muscle, indicating a tear or significant injury), the most likely diagnosis is:
Partial Tear of the External Obturator Muscle (External Obturator Muscle Tear).
If there are further doubts or to rule out other rare complications, ultrasound or follow-up MRI could be performed for dynamic assessment.
Treatment Recommendations:
Rehabilitation and Exercise Prescription (Following the FITT-VP Principle):
Note: If significant pain or discomfort occurs during training, a prompt reassessment and adjustment of the rehabilitation plan is necessary. For ballet dancers, pay particular attention to comprehensive flexibility training of the ankles, knees, lower back, and pelvis. At this stage, minimize high-difficulty, large-range jumps to ensure safety.
Disclaimer: This report is only a reference-based medical analysis and cannot replace in-person consultation or personalized medical advice from a professional. If you have any concerns or your condition changes, please consult a qualified healthcare provider promptly.
Isolated partial rupture of the left external obturator muscle
