Author: Roxana Hu, BS
Co Author #1: Justin Mark J Young, MD
Senior Editor: Jessalynn Adam, MD
Editor: Andrew Li-Yung Hing, MD

Patient Presentation:
Patient presents as an 18-year-old female, Division I soccer midfielder with a history of 10 degree spinal asymmetry and history of a surgical repair for a right shoulder superior labrum from anterior to posterior (SLAP) tear. She initially presented with left hip pain after she tripped while running during a late season traveling game. She was removed for the remainder of the game and was treated with NSAIDs and ice for a presumed hip-flexor strain. She played the remaining travel games but upon returning home noticed persistent pain with worsening symptoms for one month. She underwent a left hip arthroscopy and labral repair, with resolution of symptoms for 1 year. During this year, she did not train at full capacity due to the soccer season disruptions from the COVID-19 pandemic. She presented with recurrent left hip pain and stiffness after returning to full-capacity training with the start of season, and subsequently sought re-evaluation.

History:
Past medical history includes 10 degree scoliosis, right shoulder superior labral tear from anterior to posterior, and left hip arthroplasty with labral repair.

Physical Exam:
Vitals: 5ft & 5in;, 117 pounds.
General:comfortable, no distress.
Cardiac:regular rate and rhythm, no murmurs.
Lungs:no labored breathing, clear to auscultation bilaterally.
Left hip: ROM: decreased left hip extension, decreased hip external rotation and internal rotation on left by 50%. Sensory: intact to light touch.
Special Tests: Ober's: positive, Flexion, Abduction and External Rotation FABER: positive, Flexion, Adduction and Internal Rotation FADIR: positive, Scour (labral integrity): negative, SLR: negative, Stork test: negative; Palpation: Tenderness to palpation of the anterior hip femoroacetabular joint/iliopsoas (FAJ/IP); Strength RIGHT/LEFT: Hip flexion 5/5 5-/5, Hip abduction (sidelying) 5/5 5-/5, Hip extension (prone) 5/5 4+/5, Hip adduction (sidelying) 5/5 5/5, Hip ER (supine) 5/5 5-/5 Hip IR.

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