An 18 year old male NAIA college soccer player presented with right hip pain. The original injury occurred approximately four months ago, prior to the end of spring season, when he fell onto the right posterior hip causing minor discomfort. The right hip pain continued for the remaining two weeks of spring practice and resolved with rest during the summer vacation. On reporting to school in August, he was asymptomatic and initiated a plyometric training regimen. After the first week of drills, he developed posterior right hip pain that was also exacerbated by cutting and jumping activities.

He was treated conservatively by the athletic training staff with OTC NSAIDs, ROM and stretching exercises, and various other modalities, such as moist heat, ice, and galvanic stimulation. He improved minimally over the next month and was therefore referred to the sports medicine clinic.

The PMH was unremarkable. He denied any GU or back symptoms.

Right hip had normal range of motion, as compared to the left, however the patient described pain at the extremes of internal and external rotation, and extension. Tenderness was noted over the posterior aspect of the proximal femur. Strength was 4 out of 5 with manual testing on flexion, extension, adduction, and external rotation. Neurovascular exam was normal. No masses were palpated. Genitourinary exam was unremarkable.

Initial Differential Diagnosis Based on the History and Physical: