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I-test: 31-year-old female runner with 5-week history of hip pain
  1. J O'Brien1,
  2. J Taunton2,
  3. J Larsen3,
  4. B B Forster1
  1. 1Department of Radiology, University of British Columbia Hospital, Vancouver, British Columbia, Canada
  2. 2Department of Sports Medicine, University of British Columbia Hospital, Vancouver, British Columbia, Canada
  3. 3Primary Care, University of British Columbia Hospital, Vancouver, British Columbia, Canada
  1. Correspondence to Dr J O'Brien, Department of Radiology, University of British Columbia Hospital, G63 Purdy Pavillion, 2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada; juliemobrien{at}gmail.com

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A 31-year-old woman presented to her primary physician with right groin pain of 5 weeks duration. There was no definite precipitating injury; however, before developing the pain, she ran recreationally, approximately 10 km, three times per week.

Initially she experienced discomfort after exercise; however, after 2 weeks she began to develop pain after 6 or 7 km, which was relieved by rest.

The pain gradually became more severe, often occurring when she began to exercise and sometimes the symptoms recurred at night. Throughout this time, the pain was localised to the right groin, without radiation to her back or down her leg.

She had no significant past medical or surgical history and was not taking any medications. She admitted that she was careful about her diet to maintain her weight and had a regular menstrual cycle.

Her physical examination was unremarkable, with full range of movement only limited by patient discomfort.

A radiograph of her hip was performed (figure 1).

Figure 1

What is the diagnosis?

She was referred for physiotherapy; however, the pain persisted and she returned to her primary physician 2 months after her initial presentation.

On this occasion, there was some weakness and discomfort on right hip adduction, otherwise her examination was unremarkable.

She was referred for a magnetic resonance imaging (MRI) examination of her pelvis (figure 2).

Figure 2

What is the diagnosis?

Following these investigations, the patient continued to exercise as before, limited by discomfort despite the advice of her physician. Six weeks later she re-presented to the physician with an exacerbation of the right groin pain.

On this occasion, she demonstrated an anthalgic gait and significantly limited hip flexion as well as abduction and adduction of the right hip.

What is the diagnosis?

Diagnosis

Femoral neck stress fracture (FNSF), with subsequent progression to a complete fracture of the right femoral neck. …

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