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Muscles of the anterolateral abdominal wall comprise three thin broad aponeurotic layers, namely the external oblique, the internal oblique, and the transverse muscles. 1, 2 On either side of the midline there is also a wide vertical muscle, the rectus abdominis. The internal oblique muscles lie under and are hence protected by the external oblique, with fibres from each running perpendicular to one another. 3 The internal oblique originates from the lumbar fascia, the anterior portion of the iliac crest, and the inguinal ligament. It inserts superiorly on the 9th, 10th, 11th, and 12th costal cartilages, along the linea alba, and is continuous with the internal intercostal muscles. 1, 2 The internal oblique muscles are the flexor and ipsilateral axial rotator. They derive their nerve supply from the six lower thoracic and the first lumbar nerves. 1, 2
Rectus abdominis injuries are common in tennis players at all levels of competition. 4, 5 Most lesions affect the non-dominant muscle, and the tennis movement primarily involved in the injury mechanism is usually the serve. 4- 6 In contrast, lateral abdominal muscles are rarely injured, and there is little information about this lesion in sports medicine literature. Internal oblique injuries have been reported as part of "side strain syndrome" in only a few sports activities such as cricket, ice hockey, and hurdles. 3, 7- 9 To the best of our knowledge, there is no description of internal oblique injury in tennis players.
The purpose of this report is to describe a case of acute strain of the internal oblique abdominal muscle in a professional tennis player.
CASE REPORT
A 22 year old, right handed professional tennis player presented with acute pain along the left anterolateral abdominal wall during a practice session. He complained of sudden pain after uncoordinated twisting while executing a one handed backhand. On immediate examination by the first author, he presented mild discomfort, tenderness close to the anterior rim of the 11th and 12th ribs, pain on the contraction against resistance manoeuvre, on stretching the left lateral abdominal wall, and also during deep inspiration. Radiographic evaluation was normal, and magnetic resonance imaging (MRI) on the same day showed increased...