Author: Robert Alcott, DO
Co Author #1: Kevin E. Burroughs, MD

Patient Presentation:
A 17 year old male cross-country runner presented with a complaint of severe right hip pain and stiffness. Two weeks earlier he noticed some mild soreness in his groin during one of his typical 8 mile training runs. He subsequently competed in two cross-country meets, but experienced increasing pain and during the second meet had intense pain in the groin causing him to stop running. Three days later he presented to his PCP still in severe pain and with a loss in range of motion. Radiographs of the hip were reported as normal. He was started on hydrocodone for pain and referred to Sports Medicine. He arrived in our clinic in a wheel chair, was unable to bear weight and said he could not move his leg in any direction without intense pain. He denied any fevers, chills, night sweats, or weight loss.

History:
Past medical, surgical, social, and family histories were unremarkable.

Physical Exam:
Vital signs - Temperature 99.4 F, Heart Rate 60, Respiratory Rate 14, Blood Pressure 110/70, Weight 126lbs.
General - well developed, well nourished, lean build. Difficulty with transferring to the examining table.
Right Hip - No swelling or ecchymosis. active range of motion and passive range of motion limited in all planes due to pain. Strength 2 out of 5 in flexion, 3 out of 5 in extension, adduction, and abduction. Passive internal rotation caused severe groin pain, but log roll did not cause pain.
Right Leg - No soft tissue mass or swelling. Severe tenderness to palpation over the anterior thigh and along the adductor musculature. There was tenderness to palpation along the medial thigh, but also to the superior aspect of the knee. The remainder of the lower extremity was neurovascularly intact.

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