Bilateral Hip Pain in a Female Adolescent Runner

Abstract

HISTORY: Sixteen year old female runner presents with 4 months of right hip pain and 2 months of left hip pain. the right hip pain began gradually during track season. She was a distance runner, but no specific trauma or injury. The right hip pain was treated initially with stetching exercise which helped some. In the last 2 months, she has also developed left hip pain. This pain had a gradual onset with no known truama or injury. This pain has gradually gotten worse until she is now unable to run at all without pain. She quit running 10 days ago with some improvement. She gets ocassional painless popping over the right greater trochanter, but no clicking, locking or giving out of either hip. She has a history of right fibular stress fracture. She has been diagnosed with hyperthyroidism due to Grave's disease. Menstrual cycles have been regular for several months. Her nutrition and body image are both normal. PHYSICAL EXAMINATION:General: Cheerful, slight female. Vital Signs: Stable, height in 50th percentile, weight in the 25th percentile. Low Back: Non-tender, no defomity, and no step-off. Range of motion full. Sacrum tender to palpation and compression. Mildly tender over the SI joints left and right. No obvious deformity. Right Hip: Localized pain over the posterior greater trochanter. No deformity. Pain with resisted internal and external rotation of the hip. Mild pain with resisted hip flexion. Postive Thomas test and fulcrum. Otherwise stable and full strength and range of motion. Patricks test negative. Left Hip: pain over the hip flexors but no deformity. Positive Thomas test. Minimal pain with fulcrum test. Otherwise stable hip with full motion and strength. Patricks negative. DIFFERENTIAL DIAGNOSIS: Bilateral hip strain, right hip flexor and short rotators, left hip flexor Hip bursitis Stress fracture neck of the femur Legg-Calve-Perthes disease Juvenile Rheumatoid Arthritis Osteosarcoma TEST AND RESULTS: Xray: Right hip normal, Left hip normal MRI: Hip, Pelvis, Sacrum shows inflammation and tendonosis fo the left and right iliopsoas muscles. Abnormal signal in posterior sacrum left greater than right. Probable stress fracture of the sacrum. FINAL WORKING DIAGNOSIS: 1. Bilateral hip flexor strtain. 2. Stress reaction of the sacrum. TREATMENT AND OUTCOMES: Out of running for 3 months. Physical therapy for stretching and strenghtening program. Repeat xray at 3 months. Gradual return to running.