AMSSM Home
AMSSM On FaceBook AMSSM On Twitter AMSSM On Linkedin
 

Disabled Despite Dmards: Refractory Hip Pain In An Adolescent Athlete - Page #3
 

Lab Studies:
CBC with mild normocytic anemia (Hgb 12.0)
CRP and ESR normal
CMP normal
HLA B27 negative
Anti-CCP Ab negative
ANA negative
RF negative
Vitamin D insufficiency (vitamin D 21.6)
Fecal calprotectin normal
Fecal occult blood test negative
Repeat labs during rheumatology treatment/workup normal apart from anemia

Other Studies:
Initial hip radiograph was read as bilateral cam morphology, but the right hip was otherwise read as normal Case Photo #1 . In retrospect, there is a faint well-circumscribed 0.5 cm diameter lucency with surrounding sclerosis at the anterolateral aspect of the right femoral neck.

Subsequent MRI showed complex joint effusion, edema at the lateral femoral head/neck junction, and incidentally noted labral tear with chondromalacia Case Photo #2 . This MRI prompted referral from primary care to rheumatology.

Repeat MRI 1 year later after failure to respond to biologics again showed large joint effusion with synovial thickening, as well as a new nidus along lateral cortex of the right femoral head/neck Case Photo #3 . There was debate amongst radiologists about whether this could represent an osteoid osteoma, synovial pit due to cam morphology and underlying arthritis, or even an atypical infection. Case Photo #4

Follow up CT scan showed a cortically based lucent lesion with central sclerotic nidus along the right anterior femoral neck, consistent with an intra-articular osteoid osteoma Case Photo #4 .

Consultations:
Rheumatology, Sports Medicine, and Radiology were all involved.

Click here to continue. Challenge yourself by writing down a revised, working 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.
 

UPCOMING EVENTS


_________________________________

11/19-11/22/2026
2026 AMSSM/OHSU Introductory &/or Diagnostic/Interventional Sports US Course

_________________________________

12/04-12/06/2026
2026 Advanced Team Physician Course

_________________________________

4/16-4/21/2027
2027 AMSSM Annual Meeting

FIND A SPORTS DOC

Please enter a search term relevant to the search type. For US States - use only letter abbreviations.

Choose Search Type

Zip Code: 

 Choose Search Radius: 

© The American Medical Society for Sports Medicine
4000 W. 114th Street, Suite 100
Leawood, KS 66211
Phone: 913.327.1415


Website created by the computer geek