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Hip Pain: When It Just Won't Go Away - Page #1
 

Author: Tracey Viola, DO
Co Author #1: Hamish A. Kerr, MBChB, MSc
Co Author #2: Shankar P. Das, MD

Patient Presentation:
17 year old male with right-sided hip pain for 5 weeks.

History:
While diving for the ball in football practice, he landed on his right hip. There was initial improvement with ibuprofen. He continued playing despite pain. He reaggravated the injury approximately 1 week ago when doing hill conditioning at practice. Pain is described as located in the groin, non-radiating, sharp, with severity of 6-7/10 and occasional increases towards 10 which last a few seconds. Pain is worse with movement. Pain is alleviated with medications and ice. ROS otherwise negative.
PMH: Concussion X 3 (2006, 2007, 2009)
No prior surgical history
Medications: No current medications
Allergies: NKDA
Family history: Parents/siblings healthy
Immunizations: UTD including seasonal flu
Social history: HS student, average grades B/Cs. Lives with family, plays baseball, football, snowboards. Denies sexual activity, recreational drugs, smoking or alcohol

Physical Exam:
Hip exam: no edema or erythema, non tender to palpation. FROM with flexion to 120 degrees. Points to pain over greater trochanter with internal and external rotation. Pain reproduced by Freiberg maneuver (forceful internal rotation of the extended thigh), resisted leg extention, straight leg raise, abduction against resistance, and FADIR testing (simultaneous flexion, adduction, and internal rotation).

Back exam: Lumbar spine FROM, no spinous process/paraspinal TTP.

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


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