Right Hip Pain In A Female Cross Country Runner

HISTORY: A 15-year-old female high school cross-country runner presented to the office with right hip pain which occurred 10 days prior to arrival. Pain is located to the lateral right hip. Running exacerbates her pain. Endorses limp with her gait. This is her first year in cross country and notes she did not train over the summer. She typically runs 20 miles per week. She eats a normal, well-rounded diet. Has normal menstrual cycle. No history of prior stress fractures. Denies feeling a pop or experiencing trauma. PHYSICAL EXAMINATION: BMI: 19.1General: Well appearing, no acute distressMSK R hip: Inspection: no swelling. Palpation: tenderness at greater trochanter and slightly distal on lateral femur. ROM: Full internal/external rotation. Strength: 5/5 SLR. Provocative tests: pain with FADIR. Functional tests: Limp/antalgic gait, pain with standing on single leg. Neurovascularly intact distally. DIFFERENTIAL DIAGNOSIS: Femoral Neck Stress Fracture, Pelvic Stress Fracture, AIIS apophysitis, Greater Trochanter Pain Syndrome, Hip Labral Tear TEST AND RESULTS: Right hip xray: normalRight hip MRI: Focal stress reaction at the lateral margin of the right iliac wing underlying the gluteus minimus muscle. Mild right iliopsoas bursitis. Small bilateral hip joint effusions. FINAL WORKING DIAGNOSIS: Right iliac wing stress fracture TREATMENT AND OUTCOMES: Patient had discontinued cross-country since her injury. She followed up 1 week after the initial visit. Her pain was improved but noted it was still present and worsened with ambulation. The patient was again seen in 2 weeks. Her pain had completely resolved. She sat out the remainder of the cross-country season. Her vitamin D, calcium, complete blood cell count, and comprehensive metabolic panel were within normal ranges. She was recommended to continue to refrain from running for 2 more weeks (total of 6 weeks running cessation) and then start physical therapy and to progress as tolerated.