A High School Volleyball Player With Thigh Swelling - Page #1

Author: Rachel Chamberlain, MD
Editor: Brian Vernau, MD

Patient Presentation:
17 year old female high school volleyball player presented to ATC with medial, proximal right thigh swelling
First noticed shortly after volleyball season began without known injury. She complains of pain with activity. ATC measured a 5x5 cm area of swelling. ATC was concerned for a hematoma, and treated with stretching and NSAIDS, re-assessing weekly.

After no improvement for two weeks patient was evaluated by team physician on sideline of Friday night football game

She denied numbness or tingling, negative for fevers, chills, night sweats, adenopathy, and other areas of swelling

migraine headaches (occasionally takes naproxen)
seasonal allergies (takes cetirizine)
Social History: Senior in high school, lives with parents, does not smoke, use drugs, drink alcohol, is not sexually active, not on oral contraceptive pills.
Family History: negative for pediatric cancers, significant for both grandfathers with prostate cancer, and mother with psoriasis

Physical Exam:
General: no distress
Pulm: normal work of breathing
Neuro: Alert, oriented x3
Psych: Normal mood and affect, insight and judgment appear intact
Skin: no erythema, rashes, lesions

Right thigh:
Right upper thigh obviously larger than left
Mass to right proximal medial thigh Somewhat firm, not indurated, measures 5x6 cm, no obvious fluctuance. Nontender to palpation, no pitting edema. 2+ pulses.
Full ROM of hip and knee without pain
Strength 5/5 and symmetric, no pain with strength testing
Normal sensation of right lower extremity

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NOTE: For more information, please contact the AMSSM, 11639 Earnshaw, Overland Park, KS 66210, (913) 327-1415.

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