A Rare Cause Of Unilateral Leg Pain In A Competitive Triathlete

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A Rare Cause Of Unilateral Leg Pain In A Competitive Triathlete - Page #1

Author: John Rolshoven, MD Co Author #1: Mark Sakr, DO Senior Editor: Justin Mark Young, MD, FAMSSM Editor: Kent Do, MD, DPT Patient Presentation: A 22-year-old female triathlete with a history of bilateral L5-S1 decompression and discectomy presented to clinic with left leg pain. She reported a two-year history of progressive left leg pain occurring during maximal exertion, particularly with running and cycling. She remained asymptomatic during submaximal activities and swimming. The pain was described as a deep ache originating in the left hip and radiating down to the calf and foot, with symptoms resolving within minutes after cessation of activity. History: Notably, her power meter data demonstrated reduced left leg output during symptomatic episodes. Most recently, during a triathlon, she experienced numbness and a cold sensation in the left shank and foot. A magnetic resonance imaging (MRI) study of the left hip performed two years prior was interpreted as normal. She denied any history of lower extremity surgery or injury (aside from her spinal procedures), and reported no personal history of deep vein thrombosis or known coagulopathy. Physical Exam: Tenderness: None to palpation of the entire left lower extremity. Gait: Normal Range of motion: Left hip passive range of motion full and pain free Special Tests: Pain free log roll, FADIR, and FABER tests. Negative slump and femoral nerve stretch test. Skin: No ecchymosis, erythema, induration, or swelling. Neurovascular: 2+ pedal pulse. Normal capillary refill. Sensation intact to crude touch. Strength 5/5 with flexion/extension of hip and knee, plantarflexion, and dorsiflexion of the ankle. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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