Author: Jessica Suba, DO
Co Author #1: Shawn Spooner, D.O.
Senior Editor: Rachel Coel, MD, PhD

Patient Presentation:
A 10 year old previously healthy female who is active in basketball and fast pitch softball presents to a sports medicine clinic with 4 months of right hip pain Case Photo #1 .

History:
The pain started insidiously with no known mechanism of injury. The patient was sent to physical therapy by her pediatrician; however, despite one month of treatment, her hip pain was still progressing. She had been continuing with modified participation in both of her sports for the last four months as she could ambulate without disability. Her pain worsened and began to refer to her ipsilateral thigh with running and during the lunge portion of her pitching cycle. The patient is an otherwise healthy female who recently experienced a growth spurt. She has no recent illnesses, no significant past medical history and no surgical history. Family history is notable for autoimmune hypothyroidism in both her mother and sister.

Physical Exam:
On examination, the patient is a tall, thin Caucasian female who is resting comfortably in no acute distress. HEENT, heart, lung and abdominal exams are unremarkable. Patient is prepubertal at Tanner stage 1. Her gait demonstrates a short stride with normal heel to toe progression and is non antalgic. On inspection of her right leg and hip, there are no visible deformities or swelling. The right leg is slightly shorter and more externally rotated than the left at rest. She has tenderness to palpation over her right hip flexors and has decreased strength (+4/5) with flexion and internal rotation, limited by pain. Right hip has decreased range of motion with internal rotation and has obligate abduction and external rotation with passive hip flexion on the right, otherwise known as a positive Drehmann sign. There are no sensory deficits and all lower extremity reflexes are intact. The remainder of the musculoskeletal exam is unremarkable.

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