A Puzzling Case Of Hip Pain In A Soccer Player - Page #1

Author: Elizabeth McBee
Co Author #1: Bradley McCrady DO
Co Author #2: Bradley McCrady DO
Co Author #3: Bradley McCrady DO
Editor: Heather Rainey, MD
Senior Editor: Kristine Karlson, MD, FAMSSM
Editor: Heather Rainey, MD
Senior Editor: Kristine Karlson MD

Patient Presentation:
A previously healthy 19-year old Division 1 female soccer player presented with intermittent stabbing right hip pain and low back pain for the past three years. The pain was localized to the right anterior and lateral hip, along the rectus femoris tendon, TFL, and gluteus medius. She denied any inciting event or trauma. The patient indicated her pain was worse after exercise, specifically after running and extending her leg to kick. She reported taking Ibuprofen 400 mg p.o. daily for pain, which helped mildly. She denied numbness, tingling, weakness, popping, locking, or clicking in her hip. She had completed several rounds of physical therapy over the past three years, which helped some, but did not completely alleviate her pain.

Past medical history is significant for mild intermittent asthma and seasonal allergies. Her medications include Zyrtec and Albuterol inhaler as needed. She had no previous surgical history and no prior fractures. Social history reveals the patient is sexually active with one partner, has never smoked, exercises frequently, and has no recent travel outside of the country.

Physical Exam:
Physical exam revealed right hip tenderness to palpation along the anterior inferior iliac spine and rectus femoris tendon, along the tensor fascia lata up to the anterior superior iliac spine, and down the iliotibial band. Exam revealed a single gluteus medius tender point in the superior iliac ridge. She had full active range of motion through the hip with pain at maximal flexion of 120 degrees. She had pain with resisted internal rotation, abduction, and adduction. Patient had a positive Nobel and Obers tests. She also had a positive scour test, however the pain was more localized over the origin of the rectus femoris, rather than through the acetabulum and labrum. No visible ecchymosis is noted on inspection. Strength is 5/5 in all planes of motion, sensation is overtly intact, and deep tendon reflexes were 2/4 bilaterally.

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