Hip Pain In A College Runner - Page #1

Author: Ryan Siegel, DO, ATC
Co Author #1: James Borchers, MD
Co Author #2: Kendra McCamey, MD
Editor: Amy Valasek, MD, MS

Patient Presentation:
This is a 21 year-old female who presented with progressively worsening left hip pain with running over the previous 8 weeks without history of a mechanism of injury or trauma.

She had been abroad where she was evaluated and diagnosed with a muscle strain, and instructed to follow-up in the United States when she returned home. She was seen at an orthopedic office in her hometown who diagnosed her with inflammation and was instructed to do activity as tolerated. At the time, an x-ray of her left hip was reported to her as negative. Despite rest, NSAID use, and modified activity (non weight- bearing), her anterior and lateral hip pain persisted and at the time of presentation, she had an inability to bear weight, loss of range of motion, and hip weakness. Her pain was described as sharp with an intensity of 6/10. Any movement or weight-bearing activity exacerbated her symptoms. She denied any back pain, loss of sensation, or numbness or tingling into her distal extremities. She has no prior problems with this area in the past. Prior to having pain, the patient was doing interval training and running daily, about 12 miles per week.

Physical Exam:
VS: HR 60, BP 110/64, Ht 55, Wt 51 kg/113 lbs
Gen: Well-developed, well-appearing female, in no apparent distress. Alert and oriented x 3.
MSK: Left hip without deformity or ecchymosis. On palpation, there was tenderness over the anterior aspect of the hip and slight tenderness over the lateral aspect. There was full active and passive ROM with pain in all directions. Her muscle strength was 4/5 in abduction, adduction, and flexion. There was a positive FABER test and a negative Ober test. She experienced significant pain with a one-legged hop and balance testing.
Neuro/Vascular: There was normal pulses and sensation with +2/4 reflexes in both patella and achilles bilaterally.

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