Author: Barbara Semakula, MD
Co Author #1: Ryan Rodd, ATC
Co Author #2: Mark Milia, MD

Patient Presentation:
A previously healthy 15 year old male was participating in a junior varsity high school football game. During the first half of the game the patient felt pain and tightness in his left hip.

During the third quarter, while running into the end zone, he felt a pop in his left hip and had sudden onset of sharp, non-radiating pain localized to his left anterior hip. He stopped suddenly was tackled moments later. He was unable to move his left leg without pain.

The pain was described as pressure-like, sharp, non-radiating, localized to the left anterior hip, and with severity of 8/10 increasing to 10/10 with movement.

History:
Past Medical History: None
Past Surgical History: None
Medications: No current medications
Allergies: No known drug allergies
Family History: Parents and siblings are healthy
Immunizations: Up to date including seasonal flu
Social History: High school sophomore student with average grades. Lives with family. Plays football and basketball. Denies sexual activity, recreational drugs, smoking or alcohol.

Physical Exam:
General: Alert and oriented to person, place and time.

Cardiac: Regular, rate and rhythm

Lungs: Clear to Auscultation

Abdomen: Bowel sounds were present. Non-tender and non-distended. No hepatospleenomegaly. No masses.

Hip/groin: Gait was not examined secondary to pain. Pain with log roll manuevers. Limited Flexion, abduction, and external rotation (FABER) secondary to pain. Limited range of motion. Less than 10 degrees with hip flexion and extension and 20 degrees with hip adduction and abduction. No localized swelling. Severe tenderness on palpation of left hip at the anterior superior iliac spine. No tenderness to palpation of the left trochanter, ischial tuberosity, or anterior inferior iliac spine.

Lumbar Spine: Full range of motion. No tenderness on palpation of the spine, iliac crests, or posterior sacroiliac joint. Straight leg exam is limited secondary to pain but otherwise unremarkable bilaterally.

Knee/ankle: Hip pain with knee flexion and extension. Lachman's test and posterior drawer test are normal. Unable to perform McMurray's test secondary to hip pain. Varus and Valgus stress tests were normal. Full range of motion at the ankle.

Vascular: femoral artery palpable with 2+ pulses bilaterally. Dorsalis pedis and posterior tibial pulses palpable with 2+ pulses bilaterally.

Neurologic: Sensory exam is normal. 5/5 strength throughout except hip flexion was limited secondary to pain. Reflexes 2/2 and Babinski's sign was absent.

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