Hip Pain - High School Track Athlete

Abstract

HISTORY: 17 year old female track and cheer athlete presents to our sports medicine clinic with lateral and anterior left hip pain with snapping which had been present for 6 months. The lateral hip pain was worse with activity and associated with snapping. Anterior hip pain was deep and present even while at rest. No numbness or tingling. No fever or chills. She recalled no mechanism of injury or prior symptoms. She had been seen 4 weeks prior, diagnosed with trochanteric bursitis for her lateral pain, and treated with oral prednisone after declining an injection. She then attended formal physical therapy for pelvic stabilization, ASTYM and eccentric strengthening for her hip abductor /flexors. Despite these efforts, she had seen little improvement. PHYSICAL EXAMINATION: Tender to palpation on left greater trochanteric bursa and on the left hip flexor tendons. Decreased hip abduction strength on left with medial collapse on single leg squat. Tight IT band on the left compared to right. Full IR/ER ROM of the hip with no pain and negative impingement tests. No snapping palpated with ROM. Normal femoral pulses. No adenopathy. DIFFERENTIAL DIAGNOSIS: 1. Greater trochanteric bursitis/Gluteus medius tendinosis 2. Iliopsoas bursitis/Hip flexor tendinosis 3. Acetabular labral tear 4. Hip impingement 5. Femoral stress fracture 6. Ovarian dermoid cyst 7. Fecalith 8. Phebolith TEST AND RESULTS: AP pelvis with cross-table lateral of left hip -No significant hip abnormality is identified. -Triangular 1.1cm pelvic calcification of undetermined exact location and etiology. 45° and 90° Dunn views of pelvis -Normal Dunn views, opaque foreign body Repeat AP pelvis - 1 month -Similar to prior imaging, 1.1cm triangular calcification CT of pelvis with and without contrast -8.8x6.2x8.3cm mixed density mass arising from right ovary consistent with ovarian dermoid cyst FINAL WORKING DIAGNOSIS: 1. Ovarian dermoid cyst 2. Left hip pain secondary to ovarian dermoid cyst versus hip flexor tendinosis versus acetabular labral tear TREATMENT AND OUTCOMES: 1. Referral to OB/GYN for surgical consultation 2. Continue home exercise program of eccentric strengthening of hip flexors and abductors 3. Possible MRA of hip if hip pain not improved with surgical removal of dermoid cyst and proceed as clinically indicated after MRA