Wk 5, Case 2 - Review

Patient History: 13-yo male with bilateral hip and leg pain
Findings
SKELETAL: No macrofracture or stress reaction. No destructive bone lesion. Open physes without injury. Bilateral symmetric coxa valga: Right femoral inclination angle of 154 degrees. Left femoral inclination angle of 164 degrees. Upper limit of normal is 140 degrees. Normal is 125-135 degrees in adults, but can be 20-25 percent greater at birth and 10 percent greater in children. Slightly flattened humeral heads at the superomedial aspect bilaterally, developmental variant.

PELVIS: No free fluid. No hernia.

JOINTS: Normal symphysis pubis and SI joints. No effusion, AVN or loose body.

ACETABULUM/LABRUM: No acetabular labral tear or paralabral cyst.

MUSCLES/TENDONS/LIGAMENTS: Intact ligamentum teres bilaterally. Normal hamstring origins. Normal gluteus medius and minimus insertions. Normal iliopsoas tendons.

OTHER/SOFT TISSUE: The pelvic and extrapelvic musculature is symmetric, however narrow ischiofemoral intervals result in left-greater-than-right impingement upon the quadratus femoris muscles which are edematous but not torn or atrophied. The pelvic viscera is normal. No free fluid. No hernia. Normally descended testicles.

Conclusion
1. Bilateral coxa valga with resulting ischiofemoral impingement.
2. Aspherical femoral heads, with flattening superomedially. No physeal injury, labral tear, stress reaction, or fracture.