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Bilateral Thigh Pain In A Soccer Player - Page #1
 

Author: Paul Krebs, MD
Senior Editor: Justin Mark Young, MD, FAMSSM
Editor: Kent Do, MD, DPT

Patient Presentation:
A 16-year-old female soccer player presented with two months of progressively worsening bilateral anterior thigh pain. She denied any specific traumatic event or acute injury. Her pain was localized to the midportion of both thighs, occurred exclusively with exertion, and reached an intensity of 6/10 during activity. Symptoms improved within one to two hours of rest. Despite six weeks of relative rest and multiple conservative treatments, her pain recurred with return to higher-intensity soccer activities.

History:
The patient initially developed bilateral thigh pain at the beginning of the summer soccer season. She had recently completed a multiday soccer tournament, which significantly worsened her symptoms. Previous treatment by her primary care physician included oral corticosteroids, muscle relaxants, and nonsteroidal anti-inflammatory drugs without lasting improvement. She also completed rehabilitation with her certified athletic trainer consisting of cryotherapy, therapeutic exercises, and activity modification. Although symptoms temporarily improved, pain consistently returned with increased training intensity.
She denied pain at rest, numbness, weakness, back pain, or constitutional symptoms. She reported regular menstrual cycles and adequate nutritional intake. She had no history of previous lower extremity injury or surgery.

Past Medical History: Anxiety, depression
Past Surgical History: None

Physical Exam:
Palpation: Tenderness to bilateral thighs over the anterior mid-thighs and proximal anterior femurs involving the quadriceps musculature

ROM: hips and knees full, pain-free range of motion.

Strength: 5/5 throughout lumbar spine, knees, and hips.

Neurovascular: Distal pulses intact and symmetric, sensation intact and symmetric bilaterally

Special Tests:
Hop test: (-); Fulcrum test: (-); Straight Leg Raise: (-)

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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