Groin Pain And Antalgic Gait In A High School Cheerleader

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Groin Pain And Antalgic Gait In A High School Cheerleader - Page #1

Author: Ryan Riggs, MD Co Author #1: Alec DeCastro, MD Senior Editor: Marc Hilgers, MD, PhD, FAMSSM Editor: Bret Jacobs, DO, MA, FAMSSM Patient Presentation: A 16-year-old female cheerleader with no significant PMHx presents to the ED with right groin pain and limp. History: Six days prior to presentation, she was at cheer practice doing splits. She felt fine afterwards and had no recollection of injury. The following day, she had right leg stiffness which progressed to pain behind her knee and then to right groin pain. The pain worsened until presentation to the ED. She had X-rays of the right hip, femur and knee that were unremarkable. She was sent home with a muscle relaxant and sports medicine follow up. She presented to the ED again two days later with worsening pain and difficulty with ambulation. CBC, CRP and ESR were all normal. Hip ultrasound showed no evidence of effusion. She was unable to bear weight on her leg and the pain was limiting her ability to sleep at night. She denied joint tenderness or swelling, fever, rash or congestion. Physical Exam: Vital signs normal. Constitutional: Well developed and well appearing. HEENT, cardiovascular, pulmonary, abdominal and skin exams all normal. Musculoskeletal: normal LE muscle bulk. Palpable and visualized fasciculations of right quadriceps causing muscle contraction leading to full extension of the right knee. No swelling, erythema or warmth. - Right hip: decreased ROM. TTP over right groin. FABER + pain at right hip. Strength 4/5 hip extension, 2/5 hip flexion, 5/5 hip abduction and adduction, no sensory deficits. - Right knee: decreased ROM, 5/5 strength, no TTP or gross deformity, +2 DTR. - Ambulating with antalgic gait. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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