Adolescent Cross Country Athlete With Hip Pain - Page #1

Author: David Bica, DO
Co Author #1: Brock Niceler MD
Editor: Kathryn Ackerman, MD, MPH

Patient Presentation:
Right Buttock Pain

HPI: 15 yo healthy AA male high school cross country athlete presents with 3 week history of sharp right buttock pain that is worse with running and improved with rest. Patient started his season 1 month ago with a significant increase in mileage per week from his summer training program. He was initially treated with Osteopathic manipulation therapy for SI joint dysfunction with improvement of symptoms in office and started on conservative therapy consisting of home exercises, PT, and PRN analgesics. Patient returns 1 week later with worsening right buttock pain. Pt has not participated in cross country practice and is now painful with normal daily activity. Pt is doing exercises as prescribed but has not participated in physical therapy.
ROS: Denies any mechanism of injury. Denies popping /clicking sensation of his hip. Denies radiculopathy, parasethesias, muscle weakness, or bowel/bladder incontinence.
Past Medical/Surgical History: none
Meds: none
PFHx: non-contributory
PSocialHx: Lives with parents, 9th grade HS student, denies tob/etoh/ID

Physical Exam:
Initial Exam:
VS: T 97.7°F, HR 50, RR 14, Bp 110/60, BMI 22
Neurological: AAOx3, CN II-XII intact. Normal muscle tone and coordination, 2/4 reflexes B/L, no neural tension signs
Lumbar exam: Normal range of motion with no pain. No tenderness to palpation of spinal or transverse vertebral processes
Hip exam: TTP within the posterior aspect of right hip and right sacroiliac joint. Normal full passive and active range of motion with no pain elicited
Osteopathic Exam: Left on Right sacral torsion and left anteriorly rotated innominate
1 week f/u Exam:
Musculoskeletal Exam:
Antalgic and shuffled gait favoring left leg
Pain elicited on internal rotation of R hip
Positive right Log roll
FABER and FADIR test positive on right

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