Author: David Peters, MD
Co Author #1: Philip Motley M.D.
Editor: Abiye Ibiebele, MD
Editor: Rachel Coel, MD, PhD
A 54-year-old competitive cyclist presented with right anterior hip pain and right leg weakness that started two weeks prior. She also endorsed right hamstring and calf tightness, as well as early fatiguing of her right leg, such as when going up and down stairs. In addition, she endorsed numbness radiating from the right posterior thigh down to the calf and lateral foot.
Her usual routine consisted of rides lasting about about 2 hours per day for 5 to 6 days per week with additional resistance training. She had just completed a period of hard training prior to symptom onset. She had recently rested for three days, but the symptoms persisted to the same degree. She had not been able to return to prior level of activity and had never had similar symptoms in the past. She had a hairline fracture of her pelvis about 4 years ago. She denies falls, bladder or bowel dysfunction, weight loss, fevers or chills.
The patient had an ectomorphic build. Her leg lengths were symmetric. Visual inspection of her spine revealed slight thoracic kyphosis. She had no tenderness over the spine or the paraspinal areas. Range of motion of the spine was full and painless. Her pelvic examination was without tenderness to palpation. She had full and painless range of motion of the hips and knees. Negative FABER and FADIR tests bilaterally. Straight leg raise was negative bilaterally. Strength was full and symmetric with hip flexion, extension, abduction, adduction; knee flexion and extension; ankle dorsiflexion, plantarflexion, inversion, and eversion. Sensation was intact and symmetrical over the L2-S1 dermatomes. Reflexes 2+ bilaterally. Babinski reflex was negative bilaterally. On bilateral lower extremity exam, there was normal skin color and temperature, 2+ pulses, no pitting edema, no calf swelling or tenderness.
Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.