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Adolescent hip pain

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truthseeker

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Sep 2, 2004
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    I am an athletic trainer and physical therapist. I do free screenings to area athletes. I have an 8th grade girl, menarche 2 years ago (she's 14 now) who developed some vague clicking. She is an exceptional athlete in volleyball, basketball, and track. Last week she was running 200s felt a click in her hip, finished the 200, tried to run the next one and collapsed (this was a dramatic collapse, not a tissue failure collapse - I have known this girl since she was born) She could still participate in weight lifting in school. she came in for a screening and the exam was unimpressive. FABER was symmetrical, hip impingement tests were negative, flexibility was good, strength was normal. Her pain was very vague and not palpable. I could never reproduce "the" pain in my exam. I had her do some relative rest, progressing to a little running and now she is back to her regular workouts with everyone else.
    She is obsessed with the occasional click.
    My question is, what clinical tests do you favor as the gold standards that would make you pursue adddional imaging or in my case referral to an orthopedist and second, what is the incidence of labrum tears in a 14 yo female hip.
    Knowing this girl, she is going to be hypervigilant and pay attention to every little thing that stands out as "different" when she participates. She is the girl that wears the patellar straps, has her ankles taped, wears the little elastic strap around the biceps etc. . . and has since 5th grade.
    Thoughts?
     

    lobelsteve

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    1. Attending Physician
      MRI arthrogram for Dx.

      Arthroscopic repair with experienced surgeon.

      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953303/

      I am an athletic trainer and physical therapist. I do free screenings to area athletes. I have an 8th grade girl, menarche 2 years ago (she's 14 now) who developed some vague clicking. She is an exceptional athlete in volleyball, basketball, and track. Last week she was running 200s felt a click in her hip, finished the 200, tried to run the next one and collapsed (this was a dramatic collapse, not a tissue failure collapse - I have known this girl since she was born) She could still participate in weight lifting in school. she came in for a screening and the exam was unimpressive. FABER was symmetrical, hip impingement tests were negative, flexibility was good, strength was normal. Her pain was very vague and not palpable. I could never reproduce "the" pain in my exam. I had her do some relative rest, progressing to a little running and now she is back to her regular workouts with everyone else.
      She is obsessed with the occasional click.
      My question is, what clinical tests do you favor as the gold standards that would make you pursue adddional imaging or in my case referral to an orthopedist and second, what is the incidence of labrum tears in a 14 yo female hip.
      Knowing this girl, she is going to be hypervigilant and pay attention to every little thing that stands out as "different" when she participates. She is the girl that wears the patellar straps, has her ankles taped, wears the little elastic strap around the biceps etc. . . and has since 5th grade.
      Thoughts?
       
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