Author: Alysha Taxter, MD
Co Author #1: Matt Grady, MD
Editor: Margaret Gibson, MD
A previously healthy 12 year old male presents to outpatient clinic with thigh pain.
The subject was a previously healthy football player until age 12 when he developed left groin pain without preceding trauma. He was diagnosed with tight hamstrings and ischial tuberosity apophysitis. He completed a formal course of physical therapy with slight improvement of his pain. Over the next three years, he continued to have pain about his medial thighs and progressed to having pain about his greater trochanters, anterior and medial knees, and low back. His pain worsened with activity and was not relieved with non-steroidal anti-inflammatory medications or acetaminophen. He discontinued football and basketball secondary to pain. He never reported joint swelling, conjunctivitis, fevers, rashes, or unexplained weight loss. He is stiff for 15 minutes in the morning and has difficulty walking up stairs because of pain.
Exam findings notable for normal genital exam without evidence of an inguinal hernia. There was bilateral hip pain with passive range of motion, decreased internal and external rotation, bilateral sacroiliac tenderness with lumbar flattening upon forward flexion and modified Schober of 23 cm. Greater trochanter, patellar, and plantar enthesitis was present. He also had early boutonniere deformities of the index, long, and ring fingers bilaterally without effusions.
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