A Softball Player With A Peculiar Pain

Abstract

CASE HISTORY: 12 year old female presented to clinic with worsening R groin & anterior hip pain that occurred immediately after stepping in a hole and twisting her R hip while playing softball about 2 months prior. After the injury, she continued to play for several weeks with pain but recently has been unable to play due to pain with prolonged standing, walking, and running. She was followed by her pediatrician but referred after continued pain despite physical therapy, regular home stretching, & rest. Denies snapping, popping, back pain, weakness, other joint pain, fevers, chills, abdominal pain. PHYSICAL EXAMINATION: Vital Signs: unremarkable. ABD: normal. MSK: TTP over the AIIS & groin. Anterior pain with hip flexion, internal & external rotation & adduction. Pain with Figure 4 on the left side. +Log roll, + FADIR, -FABER. Pelvis: stable to compression & distraction. NEURO: gross sensation equal & intact over superficial & deep peroneal, saphenous, sural, & tibial nerves. Fires lower extremity muscle groups equally & appropriately. Extremity: 2+ DP pulses, capillary refill <2 secs bilaterally DDX: 1. Labral tear 2. Sports Hernia 3. Iliopsoas tendinopathy 4. Avascular necrosis of the femoral head 5. SCFE TESTS & RESULTS: XR -Bilateral Hip (2 views): Normal contour & density of the bones. The hip joints appear normal. Soft tissues are unremarkable. MRI -R hip: Iliopsoas tendon, gluteus medius tendon, gluteus maximus tendon, & hamstring tendons appear unremarkable. Labrum is normal. Mass seen on the right adnexa measuring 4.7 cm. On the T1-weighted images, findings are consistent with a dermoid cyst FINAL DIAGNOSIS: Ovarian Dermoid Cyst (Mature Cystic Teratoma) TREATMENT & OUTCOME: Patient was referred to general surgery who performed a laparoscopic ovarian cystectomy & removed a non-ruptured 5cm teratoma that was confirmed by pathology & two ~2cm paratubal cysts. At post-op appointment, she reported improvement in her pain & is expected to make a full recovery.