Author: George Johnson, DO
Co Author #1: Carey A Roberts, DO USN, MC, LT, PGY-1
Co Author #2: Kevin Michael Bernstein MD, MMS, CAQSM, FAAFP USN, MC, LCDR
Co Author #3: Josh Russel Smith, DPT
Senior Editor: Marc Hilgers, MD, PhD, FAMSSM
Editor: John Hyden, Jr, MD

Patient Presentation:
A 36-year old male amateur cyclist with ankylosing spondylitis (AS), treated with adalimumab, presented to Sports Medicine clinic 5 days after a cycling accident. Patient was riding with a group of cyclists when he lost control of his bicycle hitting the brakes and flipping over the handlebars landing on the left side of his body. The patient was stabilized by Emergency Medical Service after being found to have altered mental status with head and cervical spine trauma, and brought to the emergency department for additional evaluation. Along with the diagnosis of concussion he sustained injuries to his left hip, right knee, and left elbow with multiple abrasions, contusions and chipped teeth. His right knee radiographs revealed an effusion. His brain, spine, shoulder, elbow, and hip imaging were negative for fractures or other significant acute pathology. He was released for outpatient management.

History:
None

Physical Exam:
Patient was noted to have an antalgic gait walking into the clinic. He had normal vital signs and a post-concussion assessment was unremarkable. He was noted to have facial, left shoulder, left elbow, and left knee abrasions as well as right knee ecchymosis overlying the medial patellofemoral ligament Case Photo #3 . Evaluation of the left hip revealed non-blanching ecchymosis of the intact skin with a large amount of swelling over his lateral left thigh extending from the greater trochanter anteriorly towards the groin. Case Photo #1 , Case Photo #2 , Case Photo #4 There was tenderness to palpation with fluctuance. He had full passive and active range of motion of both lower extremities, normal strength, and pain elicited with movement, worse when going from seated to standing. Examination for inguinal hernia was negative.

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