Image Quiz
Hip Pain in an Athletic Fourteen-Year-Old Boy1
A fourteen-year-old boy presented to his primary-care physician because of pain in the right hip of several weeks' duration. He initially described the pain as diffuse about the hip but later stated that it had become localized to the groin area, along the medial aspect of the proximal part of the thigh. He had recently completed a six-week session at summer football camp, which required repetitive high-impact activities, including running 2 to 3 mi (3.2 to 4.8 km) three times a week and participating in sprint workouts twice a week. After summer football camp had ended, he immediately began playing high-school football. The patient initially was treated with nonsteroidal anti-inflammatory medication and modification of activity and was instructed to remain non-weight-bearing on the right side and to use crutches for one week. Radiographs were not made. The symptoms improved with this treatment, and the patient returned to playing competitive football. The pain recurred intermittently during the next month and began to increase in frequency and severity. It became localized to the groin as the season progressed. Beyond his participation in football, the patient had no episode of trauma without a known mechanism of injury. He also had no constitutional symptoms or pain either at night or at rest. The medical history revealed no pertinent findings, and the patient was taking no medications and had no dietary deficiencies. He was then referred for orthopaedic consultation.
Physical examination revealed a well-developed, muscular male patient (weight, 90 kg) who demonstrated an antalgic gait with a normal foot-progression angle. The right hip had a full range of motion that was not associated with pain except with extreme internal rotation in extension. Anteroposterior and frog-leg lateral radiographs of the right hip and anteroposterior radiographs of the right femur were made (Fig. 1). Because of the suspicious radiographic and physical findings, magnetic resonance imaging was performed (Figs. 2-A and 2-B).
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Fig. 1 |
Fig. 2-A |
Fig. 2-B |
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