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Disabled Despite Dmards: Refractory Hip Pain In An Adolescent Athlete - Page #1
 

Author: Dharamsi Miraal, MD
Co Author #1: Georgia Griffin, MD
Senior Editor: Kristine Karlson, MD, FAMSSM
Editor: Katherine Fahy, MD

Patient Presentation:
A 16-year-old, previously healthy and active male was referred from Rheumatology to Sports Medicine clinic for 2 years of persistent right hip pain.

History:
A previously multisport athlete, he initially had pain in the right groin with increased running frequency. The pain gradually became diffuse in the right hip and was worse during the day. It intermittently radiated to the knee and the back. He also had morning stiffness in the hips and back that improved through the day, nighttime pain that woke him up, and fatigue. There was minimal improvement with acetaminophen and meloxicam. He had failed 2 months of physical therapy, as well as methotrexate, adalimumab, etanercept, and an intraarticular steroid injection. Naproxen had finally provided some relief. He had previously lost 7 kg, which was attributed to poor appetite from pain and medication side effect but had since regained weight upon presentation to Sports Medicine. He denied fevers, joint swelling, easy bruising or bleeding.

Physical Exam:
General: Well-appearing, no acute distress, no rashes.
Inspection: Gait was stiff and antalgic. No redness/bruising/swelling. Neutral alignment. Equal leg lengths.
Palpation: Diffuse tenderness to palpation throughout anterior hip.
Range of Motion: Limited and painful range of motion. Right hip flexion 70° with knee to chest, internal rotation 10° and external rotation 0°. Left hip flexion 90° with knee to chest, internal rotation 20°, and external rotation 40°.
Strength: 4/5 with right hip flexion and painful.
Special tests: FADIR positive, FABER produced anterior and lateral pain but no SI joint pain. Log roll negative.

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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