Author: Shivali Shah, DO
Co Author #1: Eric Robinson MD
Co Author #2: Anthony Beutler MD
Senior Editor: Justin Mark Young, MD
Editor: Ian McKeag, MD, MS

Patient Presentation:
A 13-year-old female complains of several years of intermittent right inner thigh pain at the mid femur level.

History:
Pain was present during the day and night. It has occasionally awakened her at night. The pain was described as sharp, like "someone pushing on a bruise," and non-radiating. The pain was improved with rest. There was no palpable mass. The family visited their pediatrician several times who thought it was growing pains. One month prior to the visit the intensity and frequency of the pain had increased. Six months ago, she quit playing lacrosse due to the severe pain experienced with activity. Since then, she has tolerated most daily activities, but still has episodic pain. She denied any numbness, paresthesias, weakness, stiffness, fevers, chills, night sweats, unintentional weight loss, or fatigue.

Physical Exam:
Inspection: Well-appearing female without obvious mass or asymmetry. No swelling or effusion present of lower extremities bilaterally.
Palpation: Patient was tender to palpation of the antero-medial aspect of right mid-thigh within the muscle body.
Range of motion: Full active range of motion of bilateral hips, knees, and ankles.
Strength: She had 5/5 strength in bilateral hip flexors, quadriceps, hamstrings, tibialis anterior, gastrocnemius, peroneals, toe flexors, and toe extensors.
Sensation: Sensation was intact to light touch throughout bilateral lower extremities.
Special Tests: FABER and FADIR maneuvers within normal limits. Mild pain was provoked with resisted hip flexion. Patient had normal bilateral knee exams including negative McMurray's test, anterior drawer, posterior drawer, varus, and valgus stress tests.

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