Image Quiz
Hip Pain in a Seventeen-Year-Old Girl
Camilo Restrepo, MD, Fabio Orozco, MD, and Javad Parvizi, MD, FRCS*,
Rothman Institute of Orthopedics, Thomas Jefferson Hospital, Philadelphia, Pennsylvania. E-mail address for J. Parvizi: parvj@aol.com
A seventeen-year-old girl was referred to our institution with a three-year history of progressive pain in the left groin. There was no history of trauma, and the medical history and family history were unremarkable. The pain was present on most days and increased when the patient performed weight-bearing activities. The patient was a very active lacrosse player, but she had been unable to play in recent months because of pain in the left hip.
On physical examination, the patient was 175 cm tall and weighed 67 kg. She had a slight limp. The Trendelenburg sign was negative. The range of motion in the affected hip was 100° of flexion, 0° of extension, 10° of internal rotation (painful), 25° of external rotation, 10° of abduction, and 20° of adduction. In contrast, the range of motion in the unaffected right hip was 120° of flexion, 0° of extension, 35° of internal rotation, 45° of external rotation, 50° of abduction, and 20° of adduction. The Impingement test1, performed by positioning the hip and the knee in 90° of flexion while internally rotating the hip, elicited pain only in the left hip. The results of neurologic and vascular examination of the lower extremity were unremarkable.
The results of laboratory studies, including a complete blood count, measurement of the erythrocyte sedimentation rate, and measurement of the levels of C-reactive protein and rheumatoid factor, were negative.
Imaging studies of the hip included plain radiographs (Fig. 1) and magnetic resonance images (Figs. 2-A, 2-B, and 2-C).
Fig. 1 |
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Fig. 2-A |
Fig. 2-B |
Fig. 2-C |
The patient underwent open dislocation of the hip and débridement. A biopsy of the synovium was performed.
Fig. 3 |
For larger view, click on image |
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