Author: Jeremy Johnson, MD, MPH
Co Author #1: Greg Landry, MD

Patient Presentation:
K.M. is a previously healthy 9-year old girl who presented with 3 weeks of left groin discomfort and a subtle limp that presented at the end of summer vacation.

History:
K.M. is a previously healthy 9-year old girl who presented with 3-weeks of left groin discomfort and a subtle limp at the end of summer vacation. She denied pain at rest and could not recall any specific injury that resulted in the discomfort. She attended summer camp 5 days a week (which invovled 2 hours of play daily), every-other-week. This camp's purpose was as a recreational introduction to various sports so had rotating sports "modules".

K.M. was previously active and in good physical condition prior to her presentation. She was involved in gymnastics during the prior school year an average of 2 days per week, though was not involved in gymnastics the summer preceding the injury.

Her mother first noticed her limp while picking her up from camp in late summer. When asked about it, K.M. stated, "my hip feels funny", however, it was not causing her distress or interfering with her activities. 3 weeks later, they participated in a mother-daughter fun 5K run, which they completed "very slowly". During the race her left hip was clearly bothering K.M. and she was brought in to see her pediatrician.

K.M. had no previous back or lower extremity injuries. She sustained a left wrist fracture at age 6, after falling off a scooter. Interestingly, she did not have significant pain initially and was diagnosed 1 week later, after developing pain during tumbling in gymnastics.

Of note, she was diagnosed with ADHD, and started on Lisdexamfetamine 20 mg daily 1 month prior to presentation. She has normal cognitive and behavioral development and has no previous hospitalizations.

Physical Exam:
Initial Exam on 9/5/13:

Height: 54.37" (55%ile)
Weight: 78 lb 0.7 oz (68%ile)
Body Mass Index: 18.56 kg/(m^2) (75%ile)
Blood Pressure: 123/69 mmHg
Heart Rate: 89 bpm
Tanner stage 2 breast buds

Hip: Subtle antalgic gait. No bony deformities. No tenderness to palpation about the groin or hip. Left hip reveals full range of motion, equal to the contralateral side. She exhibited moderate pain with passive hip flexion, internal and external rotation. 5/5 strength with hip flexion, extension, abduction and adduction. Log-roll positive. FADIR positive, FABER positive. She was neurovascularly intact in her bilateral lower extremities.

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