An Overlooked Entity in Diagnosing Hip Pain with Neuropathy in an Athletic Young Adult: A Case Report

@#Hip pain is frequently encountered in the athletic community. Femoro-acetabular impingement (FAI) is a common cause of hip pain in young adults. However, it is important to appreciate the uncommon diagnosis and the role of imaging for unexplained hip pain. The pathology behind a posterior hip pain is often misdiagnosed as the cause of hip pain is non-specific, extensive and elusive. We managed to detect the pathology through magnetic resonance arthrography (MRA) of hip with gadolinium enhancement after a series of inconclusive history, physical examination and imaging findings were completed. This particular case vignettes an overlooked osteoid osteoma that leads to the delay in diagnosis and increase morbidity.

Coxalgia en niños menores de 10 años / hip pain in children under 10 years of age

El dolor de cadera en un niño menor de 10 años es un desafío diagnóstico. La causa de este dolor puede ser inflamatoria, infecciosa o propia de un esqueleto en desarrollo. Como en todo paciente pediátrico, la clínica algunas veces no será evidente y requerirá de la experiencia del médico para poder obtener síntomas y signos que guíen el estudio. En esta revisión se presentan las causas más frecuentes de coxalgia en pacientes menores de 10 años.

Hip pain in children under ten years of age is a diagnostic challenge. The origin of the pain can be inflammatory, infectious, or proper to a pediatric growing skeleton. As in every pediatric patient, clinical history may not be evident and the physician experience will be necessary to obtain clinical features to guide the patient study. In this review, the most frequent causes of hip pain in children under ten years of age are displayed.

Successful Transcatheter Arterial Embolisation for a Traumatic Iliacus Hematoma: A Case Report

@#A traumatic iliacus hematoma is rare and usually occurs in patients after a fall involving a lower back injury. Although the hematoma may compress the femoral nerve causing femoral nerve palsy, the gold standard treatment for this condition has not been established. Here we report transcatheter arterial embolisation as a useful treatment strategy for a traumatic iliacus hematoma.

Clinics in diagnostic imaging (197). Left ischiofemoral impingement syndrome

A 48-year-old woman presented with progressive left hip pain over six months, along with left lower limb weakness for two weeks. Magnetic resonance imaging of the left hip showed narrowing of the left ischiofemoral space, oedema of the left quadratus femoris muscle and left sciatic nerve, and mild bone marrow oedema of the left ischial tuberosity. The diagnosis of left ischiofemoral impingement syndrome was made. The imaging features of ischiofemoral impingement syndrome and the associated aetiologies and complications are discussed.

Causes of Chronic Hip Pain Undiagnosed or Misdiagnosed by Primary Physicians in Young Adult Patients: a Retrospective Descriptive Study

BACKGROUND: Hip pain is a common musculoskeletal complaint in general practice. Although comprehensive diagnostic approach on hip pain is mandatory for adequate treatment, un- or mis-diagnosis is not rare in primary care. The aim of this study was to analyze descriptively un- or mis-diagnosed hip pain cases referred from primary care to a tertiary hospital, especially in young adults ≤ 50 years old. METHODS: We retrospectively analyzed a consecutive cohort of 150 patients (≤ 50 years old) with chronic hip pain (≥ 6 weeks), which was not diagnosed or misdiagnosed based on the information provided on the referral form. RESULTS: Overall an average 32 cases/month were referred due to hip pain without a diagnosis or with an incorrect diagnosis. Among them, 150 patients were enrolled in this study and 146 (97.3%) could be allocated to a specific disease by using data from routine clinical practice. Four common final diagnoses were femoroacetabular impingement (FAI) syndrome (55.3%), hip dysplasia (HD, 13.3%), referred pain from the lumbar spine (9.3%), and spondyloarthritis (SpA, 7.3%). In patients with FAI syndrome, 37 (44.0%) had pincer-type FAI and 33 (39.8%) had combined-type. Although the pain site or gender was not tightly clustered, the distribution of final diagnosis was significantly different according to hip pain location or gender. Especially, SpA or HD was not observed in younger women subgroup or elder men subgroup, respectively, when stratified by the mean age of participants. CONCLUSION: Most (> 80%) young patients with hip pain, a difficult issue to diagnosis for many primary physicians, had FAI syndrome, HD, spine lesions, and SpA. This study could give a chance to feedback information about cases with un- or mis-diagnosed hip pain, and it suggests that primary physicians need to be familiar with the diagnostic approach for these 4 diseases.

Bilateral stress fracture of femoral neck in non-athlete - case report / Fratura de estresse bilateral do colo do fêmur em não atleta - relato de caso

ABSTRACT Bilateral stress fracture of femoral neck in healthy young patients is an extremely rare entity, whose diagnostic and treatment represent a major challenge. Patients with history of hip pain, even non-athletes or military recruits, should be analyzed to achieve an early diagnosis and prevent possible complications from the surgical treatment. This report describes a 43-year-old male patient, non-athlete, without previous diseases, who developed bilateral stress fracture of femoral neck without displacement. He had a late diagnosis; bilateral osteosynthesis was made using cannulated screws. Although the diagnosis was delayed in this case, the study highlights the importance of the diagnosis of stress fracture, regardless of the activity level of the patients, for the success of the treatment.

RESUMO A fratura de estresse bilateral do colo do fêmur em pacientes adultos sadios é uma entidade extremamente rara, cujo diagnóstico e tratamento representam um grande desafio. Pacientes com história de dor no quadril, mesmo se não forem atletas ou militares, devem ser analisados para se obter um diagnóstico precoce e prevenir possíveis complicações provenientes do tratamento cirúrgico. Este relato descreve um paciente de 43 anos, não atleta, do gênero masculino, sem doenças prévias, que desenvolveu fratura de estresse do colo do fêmur bilateral sem desvio, diagnosticado e tratado tardiamente com osteossíntese bilateral com parafusos canulados. Apesar de o diagnóstico ter sido tardio nesse caso, enfatiza-se a importância de se obter diagnóstico de fratura de estresse, independentemente do nível de atividade dos pacientes, para o sucesso do tratamento.

Epifisiolistesis capital femoral: consecuencias del diagnóstico tardío: reporte de un caso y revisión de la literatura / Slipped capital femoral epiphysis: consequences of late diagnosis: a case report and literature review

La epifisiolistesis capital femoral es la pérdida de la relación anatómica entre la epífisis y la metáfisis del extremo proximal del fémur, producida por un desplazamiento a través del cartílago de crecimiento. Es la patología de cadera más frecuente de la adolescencia y su origen es multifactorial. El diagnóstico es clínico y se confirma radiológicamente. Es una urgencia traumatológica y su tratamiento debe ser precoz y quirúrgico. Es una lesión que requiere un alto índice de sospecha por parte del médico examinador y no realizar su diagnóstico a tiempo puede tener consecuencias devastadoras. Presentamos el caso de un adolescente, femenino de 12 años, quien sufrió una epifisiolistesis capital femoral, con 6 meses de evolución, no diagnosticada en su fase aguda; mostramos su evolución desde el inicio y su resolución mediante osteotomía de Dunn. El diagnóstico oportuno es la primera y única forma de evitar complicaciones a mediano y largo plazo(AU)

The slipped capital femoral epiphysis syndrome is the loss of the anatomical relationship between the epiphysis and metaphysis of the proximal end of the femoral head caused by a movement across the growth cartilage. Hip is the most common pathology of adolescence and its origin is multifactorial. Diagnosis is clinical and confirmed radiologically. It's an emergency trauma and its treatment should be early and surgical. It is an injury that requires a high index of suspicion by the examining physician and diagnose it early can have devastating consequences. We report the case of a female teenager aged 12, who presented a capital femoral epiphyseal, 6 months of evolution, which was not diagnosed in its acute phase. Introducing its evolution from the beginning and its resolution by Dunn osteotomy. Early diagnosis is the first and only way to avoid complications in the medium and long term(AU)