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Persistent Hamstring Pain In A Prepubescent Female - Page #1
 

Author: George Saborio, MD
Co Author #1: George A. Saborio
Co Author #2: Peter C. Wenger
Co Author #3: Samal, Andrey

Patient Presentation:
11 year old 10 month female presents with right hamstring pain for 3 months.

History:
An 11 year, 10 month-old female, five-discipline dancer (not en pointe) presents to the office after experiencing pain in the midsubstance of the right hamstring three months ago while doing a split. She sought a first opinion and was diagnosed with a grade 1 hamstring strain.

By the outside physician, she was prescribed physical therapy, which she did along with continuing to dance. The pain persisted for 4 weeks and the patient returned for follow-up with worsening symptoms. The diagnosis was again hamstring strain and was prescribed physical therapy and NSAIDs. Since that point, the patient sought multiple consultations with no solid answer. This included her primary, a sports medicine physician and an orthopedist.

Treatments attempted thus far: general physical therapy with modalities and deep hamstring stretching, myofascial release therapy, acupuncture, chiropractic manipulation, and topical homeopathic medications.

At the time of the visit she continues to complain of persistent, moderate right mid-hamstring pain, which worsens when she leaps and stretches. She also complains of proximal hamstring tenderness and swelling.

Physical Exam:
Lower Back exam showed the following:
-Normal spine alignment with no atrophy, edema, and deformities noted.
Right Hip and Right Upper Leg:
-Normal range of motion, however hip flexion elicited pain.
-Tenderness to right proximal hamstring.
-Hip and core weakness with resisted strength testing and supine plank test.
-Sensations and lower extremity reflexes are normal.
-Negative Trendelenburg, FABER'S, McCarthy's, Scour, seated and supine straight leg raise.
Right Knee exam was completely benign.

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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