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Betchart, C.

Mirabelli, M.

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Hip	  Pain	  in	  a	  Male	  High	  School	  Runner	  Craig	  Betchart	  MD,	  University	  of	  Rochester	  Sponsor,	  Mark	  Mirabelli	  MD	  	  HISTORY:	  	  This	  is	  a	  case	  of	  a	  16yo	  male	  cross	  country	  runner	  who	  presented	  to	  the	  sports	  medicine	  clinic	  with	  a	  chief	  complaint	  of	  right	  hip	  and	  thigh	  pain.	  	  The	  pain	  had	  been	  present	  for	  about	  2	  weeks,	  interfered	  with	  his	  running,	  and	  progressed	  to	  the	  point	  where	  it	  was	  painful	  to	  walk.	  	  He	  has	  no	  significant	  past	  medical	  history.	  	  He	  is	  a	  non-­‐smoker,	  non-­‐drinking,	  and	  non-­‐drug	  user.	  	  Family	  hx	  is	  only	  significant	  for	  breast	  cancer	  in	  his	  grandmother.	  	  	  	  PHYSICAL	  EXAMINATION:	  	  Normal	  gait,	  no	  pain	  to	  palpation,	  no	  erythema,	  no	  swelling.	  	  He	  experienced	  pain	  with	  hip	  flexion,	  that	  was	  located	  in	  the	  anterior	  groin	  and	  radiated	  to	  the	  thigh.	  	  Full	  ROM,	  full	  strength.	  	  FABER	  and	  FADIR	  reproduced	  the	  thigh	  pain.	  	  He	  refused	  to	  jump	  on	  the	  right	  leg,	  stating	  it	  would	  hurt.	  	  	  	  DIFFERENTIAL	  DIAGNOSIS:	  	  Prior	  to	  MRI:	  	  stress	  fracture,	  labral	  tear,	  FAI,	  tumor.	  	  Following	  MRI:	  eosiniphilic	  granuloma,	  osteoid	  osteoma,	  osteomyelitis	  (bacterial,	  fungal,	  tubercular),	  Ewing	  sarcoma,	  osteosarcoma,	  lymphoma,	  multiple	  myeloma,	  metastasis,	  skeletal	  syphilis,	  Brodie	  abscess,	  chondroblastoma,	  giant	  cell	  tumor.	  	  	  	  TESTS	  AND	  RESULTS:	  	  CBC,	  CMP,	  CRP,	  were	  normal.	  	  Xray	  at	  the	  initial	  visit	  was	  negative.	  	  There	  was	  concern	  for	  a	  stress	  fracture,	  so	  he	  was	  sent	  for	  an	  MRI.	  	  The	  MRI	  showed	  a	  well	  circumscribed	  1cmx2cm	  T2	  enhancing	  lesion	  in	  the	  proximal	  femur.	  	  He	  was	  sent	  to	  pediatric	  orthopedic	  surgery	  for	  bone	  biopsy.	  	  Frozen	  section	  at	  biopsy	  was	  negative	  for	  malignancy,	  and	  was	  read	  as	  “myxoid	  lesion.”	  	  The	  remainder	  of	  the	  lesion	  was	  curretted,	  and	  a	  bone	  graft	  was	  placed.	  	  The	  tissue	  was	  sent	  for	  pathology	  and	  cultures.	  	  Pathology	  reported	  as	  acute	  on	  chronic	  inflammation	  consistent	  with	  osteomyelitis,	  but	  cultures	  and	  stains	  were	  negative.	  	  	  	  FINAL/WORKING	  DIAGNOSIS:	  Aseptic	  Osteomyelitis.	  	  	  	  TREATMENT	  AND	  OUTCOMES:	  The	  definitive	  treatment	  was	  surgery.	  	  The	  patient	  recovered	  well	  after	  surgery.	  	  No	  antibiotics	  were	  given	  due	  to	  negative	  culture	  data.	  	  He	  began	  a	  graduated	  running	  program	  at	  6	  weeks,	  and	  was	  running	  pain	  free	  at	  12	  weeks.	  	  

Hip Pain in a Male High School Runner

http://digitalcommons.wku.edu/cgi/viewcontent.cgi?article=2846&context=ijesab

Hip Pain in a Male High School Runner

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