Hip Pain In A Racquetball Player

HISTORY: A 43-year-old male racquetball player with a history of hereditary multiple exostoses (HME), status post 16 osseous de-bulking surgeries of the femurs and tibias as a child, and left femur chondrosarcoma resection presented for evaluation of chronic, insidious right hip pain. Pain was prominent in the right superolateral hip with intermittent pain in the right groin, particularly with sudden hip abduction and flexion such as forward lunges. He described an intermittent catching sensation of his right hip, but no locking or popping. Two months prior to his visit, he was playing racquetball and weightlifting (lower extremities) with a trainer 3 days per week. The hip pain caused him to stop deep squatting with the trainer. He had not played racquetball for 1.5 months prior to his office visit due to pain. He denied any low back pain or lower extremity weakness. PHYSICAL EXAMINATION: Exam demonstrated 110° of right hip flexion with compensatory external rotation, reduced right hip internal and external rotation with pain at end-range of motion. Right hip impingement test, log-roll, resisted active straight leg raise, and FADIR were all positive. He did not have tenderness over bilateral greater trochanters, but mild tenderness over the right iliac crest. He was neurologically intact in bilateral lower extremities. DIFFERENTIAL DIAGNOSIS: Hip osteoarthritis; Gluteal tendinopathy; Hip labral tear TEST AND RESULTS: XR Pelvis May 2023: right hip joint space narrowing with subchondral sclerosis; dysplasia of the femoral necks with coxa valga and bilateral CAM deformities; exostoses involving the right iliac wing and bilateral proximal femurs FINAL WORKING DIAGNOSIS: Right hip osteoarthritis with bilateral CAM deformities and coxa valga secondary to hereditary multiple exostoses TREATMENT AND OUTCOMES: Patient was prescribed physical therapy to improve hip girdle strengthening, stabilization, and range of motion. He increased his gluteal strength and progressed to modified squats and agility exercises without increased pain. He has yet to return to racquetball, but he continues his return to play program. There are several case reports of total hip arthroplasty for HME with secondary hip OA, but there are limited reports of non-operative treatment of the disorder, including rehabilitation and return to sports.