Posterior Thigh Pain In A Skeletally Immature Athlete - Page #1

Author: Mohammed Aamir Saiyed, MD
Co Author #1: Angel Bermudez, MD CAQSM
Senior Editor: Kevin Gray, MD
Editor: Brian Harvey, DO

Patient Presentation:
A 14 y/o male basketball player with no pertinent past medical history presented to clinic for evaluation of a right hip injury sustained while he was out tubing on the lake four days before presentation. The patient reported that his right foot remained on the tube, and his left foot was pulled out from under him, leading to him doing a split. He felt a 'pop' and immediately had acute right hip and posterior thigh pain associated with intermittent numbness, tingling, swelling, and bruising. He reported the pain to be 4/10 in intensity at rest and 7/10 with activity. He described the pain as 'gnawing' and was more prominent during the evening. He reported that ibuprofen, rest, and heat therapy alleviated the symptoms, whereas activities including squatting, running, jumping, and twisting worsened the pain. The patient reported offloading his hip and avoiding sitting on the affected side. Review of systems was unremarkable except for swelling and pain of the right hip/posterior thigh and limitations with range of motion.

No significant past medical, surgical, or social histories.

Physical Exam:
On physical examination, the patient was in no acute distress. Vital signs were stable without any peripheral vascular or neurological deficits. There was ecchymosis 3-4cm below the right gluteal fold. There was palpable tenderness over the Quad tendon and Proximal hamstring group over the ischial tuberosity. Other regions of the lower extremity were non-tender to palpation. Range of motion was painful with log roll, internal rotation, and external hip rotation. Hip flexion was limited to 90 degrees. Extension was within normal limits. Compared to the left extremity, there was generalized weakness in strength in the right knee flexion and extension, as well as right hip flexion, extension, abduction, and adduction. Specialized tests including FADIR and FABER were painful at the hamstring.

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