HIP PAIN - ADOLESCENT SOCCER PLAYER

Abstract

HISTORY A fourteen-year-old, male soccer player injured his right hip during a soccer game. While performing a “free kick”, the player felt a snapping sensation in his right hip while following through on his kicking motion with immediate onset of anterior pain. Pt was unable to independently walk from the field. He denied any numbness, tingling, or radiation of pain. After fifteen minutes of ice he was able to ambulate independently, but with continued pain. Three days after the injury, the patient presented to the office for evaluation. PHYSICAL EXAMINATION Examination revealed the patient to have an antalgic gait. Tenderness to palpation was localized anteriorly, just inferior to the ASIS. Pain was increased with resisted hip flexion with the knee extended as well as bent. Pain also was exacerbated with passive hip extension. Scour test was negative. Flexibility evaluation noted tightness in the hip flexors, external rotators, and iliotibial band. Sacroiliac alignment was normal. Gillette, Flexion, and FABER tests were negative. Lumbar spine exam was unremarkable. Neurovascular function was intact. No hernia was appreciated. DIFFERENTIAL DIAGNOSIS Hip Flexor Strain. Apophysitis (ASIS, AIIS, and iliac crest). Slipped Capital Femoral Epiphysis. Legg-Calve-Perthes Syndrome. Labral pathology. TESTS AND RESULTS AP pelvis radiograph: – Avulsion at AIIS of right hip. FINAL/WORKING DIAGNOSIS AIIS Apophysitis. TREATMENT AND OUTCOMES Physical Therapy- ice, moist heat, electrical stimulation, flexiblility, strengthening, and functional progression. Ibuprofen 600mg TID for three weeks. Ice 10 minutes BID. Compression shorts. Relative rest- no running or kicking for three weeks. Functional progression: running initiated at three weeks; full participation in five weeks.