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An Exceedingly Rare Cause Of Thigh Pain In A Marathon Runner - Page #1
 

Author: Eric Swanson, MD, MSc
Co Author #1: Eric Swanson MD, MSc
Co Author #2: J. Mica Guzman MD, MBA, DABFM, CAQSM
Senior Editor: Justin Mark Young, MD
Editor: Jonathan Santana, DO

Patient Presentation:
A 25-year-old female with a past medical history of bipolar disease type II, generalized anxiety disorder, and benign intracranial hypertension presented to the sports medicine clinic for evaluation of right hip pain.

History:
Her primary concern was her inability to train for marathons due to her hip pain. Her pain had been present for months but became notably worse in recent weeks. She described the pain as a "deep bone pain" which was constant throughout the day and worsened to 5/10 when running. She had tried Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and topical diclofenac, neither resulted in any noticeable improvement. The patient also complained of mild fatigue but denied any fever, swelling, rash, or trauma. She denied any relevant family history.

Physical Exam:
Vitals: afebrile, HR 99, BP 118/81, BMI 39.22
MSK: The bilateral knee and hip joints were symmetrical without obvious masses, deformities, muscular atrophy, swelling, or skin changes. There was mild generalized tenderness with palpation of the right leg. The patient had full range of motion without deficits of bilateral lower extremities. The patient's gait was smooth and continuous.
Neuro: Patient's muscle strength was remarkable for 4/5 hip abduction and hip extension bilaterally Otherwise, patient had 5/5 strength in all extremities. Sensation was equal and intact bilaterally. Patient's patellar and achilles reflexes were 2+ bilaterally. Her heel-to-shin was normal, with no evidence of ataxia. Patient did not have any weakness or abnormality with toe or heel walking.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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