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A Real Pain In The Butt - Page #1
 

Author: Brooke Schutte, MD
Co Author #1: Krystle Farmer, MD

Patient Presentation:
13 year old M presented with left posterior hip pain for one month after falling directly on his left side in a football game.

History:
HPI: <br>The patient was running and fell directly onto his left side. He was not tackeled and nobody landed on him. <br>The patient was able to ambulate after the injury, but developed soreness and increasing pain three days post injury where he presented to an urgent care clinic. <br> <br>A plain radiograph demonstrated a possible coccyx fracture. He was treated conservatively with rest, non steroidal anti-inflammatory medication, and a donut seat cushion. <br> <br>Two-weeks after the injury he was diagnosed with right foot cellulitis. There was no apparent interval event that caused this. He was given a 5 day course of an antibiotic (he did not remember which). <br> <br>One-month post-injury he reported severe daily &quot;squeezing&quot; pain in the left hip and difficulty with ambulation. <br> <br>His past medical history was otherwise unremarkable.

Physical Exam:
BP: 119/80; HR: 91; BMI: 19.7 <br>Healthy, non-toxic. <br> <br>Left Hip Exam: No erythema, ecchymosis, edema, scars. Sensation intact. Femoral pulse 2+ <br>There was tenderness to palpation at the inferior sacroiliac joint and the piriformis muscle. <br>Active range of motion was significantly limited due to pain and weakness. Passive-range of motion was almost full. There was limited external rotation. <br>Strength: 3/5 Hip abduction; 2/5 Hip flexion and extension; 4/5 Hip Adduction <br>Faber Test: positive <br>No leg length discrepancy, no hip height discrepancy. <br> <br>Right Hip Exam: normal

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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