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Delayed Diagnosis Of Hip Pathology In Young Athlete - Page #1
 

Author: Morris Taylor, MD
Senior Editor: Justin Mark Young, MD, FAMSSM
Editor: Kirsten Schneider, MD

Patient Presentation:
A 22-year-old former high school football player presented with nontraumatic right-sided hip and low back pain that had been present for 3 years.

History:
His pain was located in his right low back and posterolateral right hip; and radiated down the right lower leg. He had associated "clicking" with external rotation of the hip. The pain was generally worse the morning and improved throughout the day. He had been evaluated 1.5 years ago and was found 4 months later to have a right labral tear and chondral delamination. He did not have resolution of pain after he underwent right hip arthroscopy with labral debridement and femoroplasty. He also tried physical therapy, oral steroids, and non-steroidal anti-inflammatory drugs with minimal relief. He subsequently had a trochanteric steroid injection in his right hip which helped temporarily, but he subsequently developed left-sided hip pain that was similar in character to the right.

Physical Exam:
RIGHT HIP: Tender to palpation over greater trochanter and gluteus muscles. Supine flexion to 70 degrees, 90/90 flexion to 90 degrees, internal rotation to 10 degrees, external rotation to 40 degrees. 5/5 strength with flexion, internal and external rotation, abduction and adduction. Negative log roll, FABER, FADIR. Reproducible snapping hip.
BACK: Tender to palpation over right SI joint. Nontender over spinous processes and bilateral paraspinals. Full range of motion of lumbar spine with flexion, extension, side-bending and rotation bilaterally. Negative straight leg raise.
EXTREMITIES: 5/5 strength in lower extremities bilaterally. Intact sensation in lumbar dermatomes bilaterally.
SKIN: No rashes or lesions

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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