Chief Complaint: Right hip pain.
HPI: A 26 year-old male was playing hockey when he was "checked" into the boards. The lip of the wall hit him on the right lateral pelvis. He was unable to continue play because of acute onset of pain and weakness. The injury occurred one week prior to presentation. The athlete did complain of snapping and popping in the hip with ambulation. There was significant pain with gait to the point the athlete was using crutches and not bearing weight on the right hip. The athlete noted bruising of the right hip at the iliac crest which has since resolved. He noted no swelling, tingling, numbness or loss of sensation. He denies any previous hip problems.
PMH: There are no other ongoing medical problems. Athlete was seen 1 year ago for a right wrist scaphoid fracture which healed well. Allergies - PCN
FH: There is no family history of any neurological, heart, or musculoskeletal type problems.
SH: Single, professional hockey player. He denies drug, alcohol, or tobacco use.
ROS: No other complaints.
PHYSICAL EXAM
General: A bright, alert, white male who appears acutely painful with standing and walking.
Vital Signs: Patient weights 200 pounds and stands 6'3".
Right Hip localized tenderness over the right iliac crest of the pelvis. No palpable deformity or swelling. Exquisite tenderness at the ASIS, and bruising above the iliac crest. Internal and external rotation minimally limited by pain. Significant pain with flexion and abduction of the hip and significant weakness with resistance to these motions.
Left Hip non-tender; no deformity, stable, with full motion and strength.
Right knee and ankle are stable and non-tender with full range-of-motion and full strength.
Left knee is stable and tender with full range-of-motion and full strength.
Standing Orthopedic - Weight shift to left side, giving the appearance of a short left leg. Otherwise normal alignment.
Initial Differential Diagnosis Based on the History and Physical:
