HIP INJURY- CROSS COUNTRY

Abstract

HISTORY 18-year-old high school female cross-country runner presented with one week of left anterior hip pain. Denied a specific injury. Pain started during a late season meet causing her to finish at a slower pace. Pain progressively worsened requiring crutches to ambulate, despite no further activity. Max mileage was 40 miles/week, had tapered to 20 miles/week prior to injury. History of stress fracture 4 years prior. Initial x-ray of left hip revealed open epiphyseal plates, no other osseous abnormalities. Inquiring about menstrual history, she had yet to reach menarche. Per the patient’s mother, she had been trialed on growth hormone and is currently on estradiol patches. She has a known eating disorder for which she is not actively receiving help, despite multiple hospitalizations. PMHX Primary amenorrhea, followed by endocrinology. Lab work revealed low estradiol, LH, FSH with high alkaline phosphatase. Normal labs were thyroid studies, BMP, LFT, vitamin D and prolactin. Genetics showed 46XX. Multiple XR for bone age showed that of an 11-year-old. Cardiac work up showed sinus bradycardia on EKG and normal echo. Brain/pituitary MRI revealed normal pituitary and mild enlargement of ventricles, sulci, cerebellar folia. PHYSICAL EXAMINATION Patient stands 55 inches tall, weighing 61 pounds with a BMI of 14. She appears much younger than stated age. Hair is full, though fine. Breast tissue is not appreciated. On left hip exam, there is TTP along flexor tendon, lateral hip, and piriformis. She has pain with external rotation, weakness and pain with hip flexion, abduction, and adduction against resistance. She is unable to do a single leg hop due to groin pain. She is neurovascularly intact. DIFFERENTIAL DIAGNOSIS 1. Femoral neck stress fracture 2. Primary amenorrhea 3. Hip flexor strain 4. Relative Energy Deficiency in Sports syndrome 5. ASIS avulsion fracture TESTS/RESULTS MRI left hip 1. Partial thickness tear at attachment of left iliopsoas tendon to lesser trochanter with intramuscular hematoma 2. Minimal partial thickness tear of the left common hamstring origin FINAL DIAGNOSIS 1. Partial tear of left iliopsoas tendon and hamstring 2. RED-S TREATMENT/OUTCOMES 1. Shut down from all activities 2. Weightbearing as tolerated 3. Referral to gynecology for transvaginal ultrasound 4. Referral to Eating Recovery Center