HIP PAIN - RUNNING

Abstract

HISTORY: A 38-year-old runner developed right hip and groin pain for three weeks. His pain began after increasing his running distances in preparation for a marathon. As he augmented his mileage, the hip and groin pain intensified. Initially the pain responded to cutting back on frequency of running, but he slowly developed pain in the morning and with sitting or changing position. He experienced similar symptoms 1 1/2 years ago, but this resolved with 2 weeks of rest. He has no history of prior fracture. PHYSICAL EXAM: Examination revealed full range of motion. Resisted hip flexion revealed pain and mild weakness at 4/5 on the right. Strength with internal and external rotation, extension, abduction, and adduction was normal, with minimal pain. Ober's test was negative, palpation of the greater trochanter and public rami were nontender, but Faber's test revealed diffuse pain in the right lateral hip without sacroilic tenderness. The back exam was normal, as was straight leg testing. Fulcrum test was equivocal. DIFFERENTIAL DIAGNOSIS: Hip flexor strain Labral tear Primary or metastatic malignancy Stress fracture of femoral neck Stress fracture of pubic ramus Osteoarthritis Septic joint Athletic hernia TESTS AND RESULTS: X-ray showed subtle bony reaction on the compression side of the right femoral neck. Bone scan showed increased uptake at the right femoral neck. Repeat x-rays at three weeks showed healing of the stress fracture. X-rays at five weeks showed increasing healing and calcification of the stress fracture. FINAL/WORKING DIAGNOSIS: Right femoral neck stress fracture, compression-side TREATMENT AND OUTCOME: No running. Crutches for continued or worsened pain. Non-weight bearing activities. After four to six weeks pain-free, slow return to sport with 1/2 mile slow jogging and walking, increased by 1/4 mile per week.