An Unusual Cause Of Acute Atraumatic Hip Pain - Page #1

Author: Katie Dolbec, MD
Editor: Anthony Kohlenberg, MD

Patient Presentation:
A 36-year-old male recreational deer hunter developed left-sided lumbar back and hip pain while chopping firewood. That evening, he noted a tender lump on his left hip. He presented to the Emergency Department the following day; CBC, CMP, urinalysis, and CT scan of the abdomen and pelvis were reportedly negative. He was discharged with a diagnosis of hip bursitis. Over the next 48 hours, the pain intensified and began radiating to his left groin. He presented again to the Emergency Department where pelvic ultrasound and hip x-ray were reported as negative. The pain was severe and constant; movement, weight-bearing, walking, and lumbar flexion were exacerbating. Nothing alleviated his symptoms. He denied fever, chills, abdominal pain, rash, ecchymoses, lower extremity numbness or tingling. He was discharged from the Emergency Department directly to our sports medicine office.

Past medical history included GERD, nephrolithiasis, lumbar radiculopathy, and ventral hernia. Surgical history included multiple endoscopies and colonoscopies for chronic gastrointestinal pain; he had a history of lithotripsy. The patient rarely used tobacco, drank 3-4 beers per week, and smoked recreational marijuana.

Physical Exam:
The patient’s gait was antalgic; he was unable to bear significant weight on the left lower extremity secondary to pain. There was a soft, non-mobile, flesh-colored mass, 6cm x 4cm, superior and anterior to the greater trochanter. It was more prominent with hip flexion; there was no change with valsalva. The region was exquisitely tender to palpation. Left hip range of motion was limited due to pain. Strength was 5/5 in all muscle groups, but left hip pain was worse with resisted external rotation and abduction. Sensation was intact to light touch in all dermatomes. FABER and FADIR were positive; log roll was negative. Tibialis posterior pulses were 2+.

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