HISTORY: A 46-year-old male runner with a history of right-sided L3 radiculopathy presented with one month of recurrent right hip and thigh pain. He denied any trauma, inciting event, or recent alteration in his running regimen. Pain was described as stabbing, and localized to his right lateral hip with radiation down his anterior thigh to his knee. He also reported numbness and tingling down his anterior thigh to the knee. Recently, he experienced an incident of sudden bowel urgency with near bowel incontinence. No bladder incontinence or perineal numbness. He has a history of chronic gastroesophageal reflux disease and has taken omeprazole daily for 10 years. PHYSICAL EXAMINATION: Full and symmetric lower extremity strength except for 4/5 with right hip abduction. Sensation intact to light touch at his hips, thighs, groin, buttocks, and scrotal region. No tenderness at the lumbar paraspinals, buttock musculature, greater trochanters, or anterior hip. Negative straight leg raise and reverse straight leg raise. Full, non-painful range of motion with lumbar flexion and extension. No pain with resisted hip flexion, or passive end range hip flexion. Negative FABER, FADIR, femoral nerve stretch. DIFFERENTIAL DIAGNOSIS: 1. Recurrent Upper Lumbar Radiculopathy 2. Hip Flexor Tendinopathy 3. Iliotibial Band Syndrome 4. Hip Osteoarthritis 5. Femoral Stress Fracture TEST AND RESULTS: 1. Right Hip X-Ray:- Mild osteoarthritis of bilateral hips.- Wedge sclerosis and mild periostitis of the medial aspect of the right femoral neck. 2. Lumbar Spine X-Ray:- Mild intervertebral disc height loss at T12-L1, L2-L3, and L5-S1. 3. Right Hip MRI:- Linear T1 focus with surrounding STIR hyperintensity along the medial aspect of the right femoral neck, compatible with a stress fracture. 4. Lumbar Spine MRI:- Right foraminal/extraforaminal disc protrusion at L3-L4. 5. DEXA Scan: - No signs of significant osteopenia or osteoporosis at the spine or hips. 6. Calcium, 25-OH Vitamin D, Parathyroid Hormone levels: Normal FINAL WORKING DIAGNOSIS: Right femoral neck stress fracture, potentially due to chronic proton pump inhibitor use TREATMENT AND OUTCOMES: 1. Referral to orthopedic surgery. 2. Toe-touch weight bearing for 6 weeks. 3. Discontinuation of omeprazole. 4. Consideration of future referral to endocrinology.