Thigh Pain In A Division 1 Runner - Page #1

Author: Matthew Sedgley, MD
Co Author #1: Matthew D. Sedgley, MD FAAFP CAQSM
Co Author #2: Andy Tucker, MD CAQSM
Editor: Crystal Hnatko, DO

Patient Presentation:
18 year old female complained of 3 weeks history of right anterior thigh pain.

Pain was constant, but better with rest, made worse with xc running. Located below hip joint and did not radiate. Started without trauma in an insidious manner. No associated numbness or weakness. No new footwear.

ROS Gen - no fevers, chills but loss of appetite x 2 weeks; CV - no chest pain or palpitations; Pulm -no shortness or breathe or cough; GI- no nausea, vomiting, diarrhea; Derm- no itching or rashes; GYN - no menses for 3 months out of last 12; Psych + positive for grief reaction to best friend dying from lymphoma 2 weeks ago, no homocidal or suicidal thoughts;

PSH- none
FHX- no osteoporosis
SHX no drug, alcohol, or tobacco use; strict vegetarian; avid reader
Meds: Vitamin D 500 IU daily, Vit E 1000 IU daily,
Allergies: NKDA

Physical Exam:
VS: Height 5' 1" Weight 100 pounds Pulse 56 BP 120/70 RR 12 BMI 18.9

Gen 18 year old Caucasian female well developed, thinly built.
Head Normo-cephalic, atraumatic, normal dentation, lips, gums
CV RRR S1 S2 no murmurs
Pulm CTA B no wheezes
Skin no lanugo or rashes
Inspection no bruising, edema
Palpation non tender ASIS, AIIS, greater trochanter, pubic symphysis
ROM Hip flexion 120 degrees, hip extension 15 degrees, Hip IR 35 degrees, Hip Er 45 degrees
Negative straight leg raise, Negative FABER, FADIR, Negative laxity of knee ligaments: ACL, PCL, MCL, and LCL. Positive Fulcrum sign and single leg hop test.
Strength 5/5 hip flexion, abduction, adduction, and knee extension and flexion
Psych Admits to not knowing how she feels most days, denies homocidal or suicidal thoughts, no binge eating or restricting or purging behaviors. Uses running to cope with recent grief.

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, 11639 Earnshaw, Overland Park, KS 66210, (913) 327-1415.

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