title: Pelvic osteomyelitis presenting as groin and medial thigh pain: a resident's case problem.
abstract: METHODS
  Resident's case problem.
  
  
  BACKGROUND
  Groin pain represents a diagnostic challenge and requires a diagnostic process that rules out life-threatening illness or disease processes. Osteomyelitis is a potential fatal disease process that requires accurate diagnosis and medical management. Osteomyelitis presents a problem for the outpatient physical therapist, as the described physical findings for the diagnosis of osteomyelitis are nonspecific.
  
  
  METHODS
  A 67-year-old man with groin and bilateral medial thigh pain was referred for physical therapy care to address right adductor weakness and generalized deconditioning. He had undergone extensive treatment for bladder cancer, with a recent radical cystoprostatectomy and cutaneous urinary diversion with an Indiana pouch. Postsurgical magnetic resonance imaging indicated normal findings, and the patient was currently being managed by an orthopaedic surgeon, who diagnosed the patient as having obturator nerve palsy. The physical therapist's examination produced findings inconsistent with this diagnosis. Subsequently, nuclear medicine studies revealed pubic symphysitis/osteomyelitis with secondary myositis, predominantly affecting the right adductor muscles.
  
  
  CONCLUSIONS
  Osteomyelitis represents a difficult problem for the outpatient physical therapist. Careful consideration of red-flag symptoms and inconclusive physical testing indicate the need for further medical work-up. In this case, appropriate medical management led to improvement in patient function, highlighting the need for early diagnosis.
  
  
  METHODS
  Differential diagnosis, level 4.
authors.affiliation: California Rehabilitation and Sports Therapy, Yorba Linda, CA.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Hawkins
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Sum
authors.forename: Daniel
authors.initials: D
authors.lastname: Kirages
authors.forename: Erica
authors.initials: E
authors.lastname: Sigman
authors.forename: Soma
authors.initials: S
authors.lastname: Sahai-Srivastava
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy; D006119:Groin; D006801:Humans; D064704:Levofloxacin / Q000627:therapeutic use; D008297:Male; D018908:Muscle Weakness / Q000209:etiology; D009220:Myositis / Q000175:diagnosis / Q000188:drug therapy; D009776:Obturator Nerve; D010019:Osteomyelitis / Q000175:diagnosis* / Q000188:drug therapy; D010146:Pain / Q000209:etiology*; D010243:Paralysis / Q000175:diagnosis; D010384:Pelvic Bones; D020615:Stenotrophomonas maltophilia; D013848:Thigh
chemical_list: D000900:Anti-Bacterial Agents; D064704:Levofloxacin
keywords: adductor pain; adductor weakness; differential diagnosis; pubic symphysitis; red flags