Hip Pain - Field Hockey

HISTORY:20 yo F collegiate D3 field hockey player with no pmhx presented to the Emergency Department (ED) on 9/10/24 for worsening acute groin pain onset 10 days. Patient had negative hip and femur XR. Physical exam showed no tenderness over left hip, femur, or knee. Given ketorolac IM shot and discharged. On 9/11/24, she saw her pediatrician who recommended supportive care and formal physical therapy, 600 mg of Tylenol and 1000 mg of Ibuprofen. She was started on crutches. She started treatment with her athletic trainers. On 9/17/2024, she returned to the ED for left leg pain. PE was unchanged, and she was discharged. On 9/18/24, she was seen at the sports medicine clinic. She described deep hip pain radiating to her feet. She disclosed she had anorexia nervosa and needed intensive outpatient treatment, irregular periods and was on Mirena, and decreased protein and calcium intake. Due to concerning physical exam and history plan was to order a STAT MRI and vitamin D level. PHYSICAL EXAMINATION: Left hip showing full ROM ER and IR at 90 degrees of hip flexion. FABER test showed no pain, no tightness in adductors, hip flexors, or hip rotators and no referred pain to ipsilateral SI joint pain. FADIR positive for deep pain. No tenderness to palpation over ASIS, AIIS, greater trochanter, Iliac crest, pubic symphysis, and SI joint. Ober test negative for pain, negative for tight IT band. Strength 5/5 in adduction and abduction. Positive left single hop test, unable to take one hop. DIFFERENTIAL DIAGNOSIS:1. Femoral Neck Stress Fracture 2. Acetabular Labral tear 3. Snapping Hip Syndrome (Iliopsoas) TEST AND RESULTS: MRI showed stress fracture evolving compression site inferior side left femoral neckVitamin D 25-OH: 30 ng/mL FINAL WORKING DIAGNOSIS: Right compression side femoral stress neck fracture TREATMENT AND OUTCOMES:1. Immediate non-weight bearing protocol with crutches 24/72. Supplemental Vitamin D3 3. Shut down from all activity 4. Two weeks follow-up 5. Over time progress off crutches into interval running program