Thigh Pain In A School Age Child

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Thigh Pain In A School Age Child - Page #1

Author: Alexander Pomerantz, MD, MPP Senior Editor: Heather Rainey, MD Editor: Travis Miller, DO Patient Presentation: A 9-year-old previously healthy female athlete presented to the sports medicine clinic with bilateral anterior thigh pain. History: Symptoms first began 7 months prior to presentation, when she would complain to her parents of bilateral thigh pain (right worse than left) during and after basketball games and at night. She was first seen by her pediatrician who diagnosed the problem as growing pains. However, her symptoms persisted for multiple months, continuing when she played soccer, flag football, and softball that spring. During this time, she completed 10 weeks of physical therapy leading to decreased frequency of pain episodes only. The pain attacks subsequently became more prominent, requiring her to sit out of games. Pain in her anterior thighs became especially pronounced when rising from a seated position. Ibuprofen did not improve the pain. X-rays of the femurs were benign. She otherwise had a normal appetite and growth appropriate weight gain. No fevers, chills, dysuria, hematochezia, chest pain, changes in vision, abdominal pain, or rashes. Physical Exam: General: Awake, alert. Well appearing. No rashes. Musculoskeletal: Tender to thigh squeeze bilaterally. Full internal and external rotation bilaterally. Mildly limited abduction in flexion without pain bilaterally, full abduction in extension. Popliteal angle 15 degrees. Nontender to logroll. Ely Test shows foot nearly to buttocks. Thomas Test negative. Cardiovascular: 2+ Dorsalis Pedis and Posterior Tibialis pulses bilaterally. Neurologic: Ambulating appropriately with symmetric movement of hips and knees. Bilateral Strength Testing: Hip flexor Ludloff and Stinchfield: 5/5 Gluteus Maximus: 5/5 Gluteus Medius: 5/5 Quadriceps: 5/5 Hamstrings: 5/5 Calf: 5/5 Tibialis Anterior: 5/5 Able to do 3 sit-ups and rise from a chair without pushing off with hands. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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