Hip Pain-Cross Country

Abstract

Title:Hip Pain-Cross Country Keywords:Hip pain, stress fracture, femur HISTORY: A 15 year old female cross country runner presented with 3 weeks of right groin and knee pain. She started cross country for the first time this year and had a significant increase in her mileage, from 2 miles per day over the summer up to 6 miles per day with the start of the season. On presentation, patient was experiencing pain with both walking and running and pain improved with rest. She had been on crutches for one week and had minimal improvement in her pain. She described the pain as radiating down her leg. There was no numbness, tingling or weakness in her leg. PHYSICAL EXAMINATION: Patient was alert and in no acute distress at rest. She had an antalgic gait. Right hip and knee had no soft tissue swelling or bruising. No tenderness over the pelvic region, adductors or abductors, quadriceps or hamstrings. No pain over the knee joint lines. Full, painless range of motion of the hip and knee. 4+/5 strength to hip adduction with mild pain. Full strength in all other planes without pain. Pain with right leg hop test. DIFFERENTIAL DIAGNOSIS: 1. Adductor strain 2. Apophyseal Avulsion Fracture 3. Stress fracture TESTS AND RESULTS: Radiographs, right knee, AP, lateral and sunrise-Normal alignment, no acute bony abnormalities, the patient has reached skeletal maturityRadiographs, right hip, AP pelvis and frog-leg hip-No acute bony abnormalities, normal alignmentMRI, right femur-Stress fracture of the femoral diaphysis with associated marrow edema and periosteal edema FINAL/WORKING DIAGNOSIS: Stress fracture of the femoral diaphysis TREATMENT AND OUTCOMES: 1. Non-weight bearing on crutches for 3 weeks followed by a gradual transition to one crutch and then full weight bearing when she was pain free. 2. Rehab with the school athletic trainer as well as physical therapy 3. With clinical and radiographic signs of healing at week 7, patient progressed to the stationary bike and then elliptical over the next three weeks. 4. She started jogging at week 11 and slowly added 10% distance/intensity per week 5. Athlete returned to her winter sport, basketball, 12 weeks after injury and continues to do well