Presentation:
Ella, an 11 year old school student was brought in by her mother, suffering from sudden onset right groin and anterior thigh pain.
Symptoms:
Ella’s pain was strong, deep and sharp. She could walk with difficulty but was bent forward. The only thing that aggravated her pain was straightening up.
History:
The symptoms began quickly over a 2-3day time span. There was no obvious etiology and she had suffered no trauma. She had no prior history of illness.
She was on no regular medication.
Examination:
Ella was quite tall for her age and of slim build. She appeared to be in good health and was generally bright with an, up to now, outgoing personality.
It was not possible to examine her standing because she could not stand up straight. Similarly she could not lie prone without sudden lancinating pain from her hip and groin to her knee. The only position in which she could examined was supine.
Orthopaedic:
Ella could only lie supine with her right leg flexed at the hip, any other position was far too painful.
FABER and FADIR tests were both unremarkable. She was unable to extend the involved leg beyond ~45° without extreme pain.
Abdominal palpation revealed a soft abdomen, with normal bowel sounds. The lower right quadrant was very tender to light pressure. There was no rebound tenderness and she did not have a fever.
Neurological Examination:
All cranial nerves tests were normal and bilaterally equal.
As far as could be tested, the lower limb neurology was all normal.
What Is Your Provisional Diagnosis?
If You Have A Differential Diagnosis or Diagnoses, What Is It (or They)?
What Further Tests (if any) Would You Do?
Is This A Chiropractic Case?
