Author: Bradley Jaskulka, MD

Patient Presentation:
38 year old female nurse initially presented to Orthopedic Primary Care Sports Medicine clinic with complaints of left knee pain. She presented 4 months after completing a half marathon. Denied any injury.

She was starting to train for a full marathon when the knee pain developed. She was complaining of clicking in the left knee but no locking or catching. Knee x-rays were unremarkable and the patient was diagnosed with patellofemoral syndrome and prescribed physical therapy. The patient continued to train and exercise in addition to the physical therapy. She would run outside and also had a treadmill routine. She would alternate running and walking on the treadmill.

One day after she completed physical therapy, she headed to the gym to exercise. She was performing her normal running and walking routine on the treadmill when she developed severe left hip and low back pain. Returned to clinic for evaluation of the left hip and low back pain. She was able to ambulate without assistive devices. Complained of left hip pain radiating to the groin. Denied bowel and bladder incontinence. Denied numbness, tingling and weakness of leg. The knee pain did resolve with physical therapy.

History:
Past medical history of hypothyroidism, Supraventricular tachycardia, irritable bowel syndrome, anemia, deep venous thrombosis of left lower leg complicated by compartment syndrome requiring fasciotomy and anxiety

Physical Exam:
Vital Signs:
Height: 5' 6", Weight: 160 pounds
Body Mass Index: 24.84 kg/m2
Blood pressure: 126/76, Pulse 66
Pain Scale: 8/10

Well developed female appearing stated age. Cooperative. In no acute distress. Left leg exam was neurovascularly intact. Distal pulses 2+. No obvious deformities. Knee range of motion 0 to 130 degrees of flexion. Left hip exam: Supine exam with hip range of motion within normal limits bilaterally. Pain with internal and external rotation of flexed hip. Pain with axial loading of the left hip. Log roll negative. Straight leg raise negative. No tenderness to palpation of the iliotibial band or greater trochanteric bursa. No limb length discrepancy. On standing exam she is able to bear weight and ambulate. She walks with an antalgic gait

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