Thigh Pain In A Long Distance Runner - Page #1

Author: Mitesh Patel, MD

Patient Presentation:
An 11-year-old male cross country runner presents for evaluation of a 4-month progressive history of insidious onset atraumatic anterolateral right thigh pain. Radiographs of his right femur revealed periosteal thickening involving the lateral aspect of the mid right femoral diaphysis suggesting an evolving stress fracture. He was advised to avoid all athletic activity for 1 month and use crutches with non–weight-bearing ambulation. Despite his activity modification, he reported increasing thigh pain over the course of the day at his 1 month follow up. His pain was significantly worse at night. His symptoms were alleviated with ibuprofen, only to experience predictably recurrent achiness in his thigh late in the afternoon. His gait was never compromised. His activities of daily living have remained unaffected, including walking, jumping, and sitting.

Physical Exam:
Pt. is a well-developed well-nourished white male in no apparent distress. He is alert and appropriate. He is neurovascularly intact distally in his right lower extremity. His calves are soft and nontender. He walks unassisted without a limp. He can perform a single leg stance on the right side. He can perform a single leg hop. He can squat fully without discomfort. He has minimal thigh atrophy on the right relative to the left. He has full range of motion of his right knee. He has a mild palpable deformity but no tenderness over the anterolateral aspect of his right thigh at the mid shaft level.

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