Make the Diagnosis: Spring 2015

NK is a 17-year-old otherwise healthy girl with a 1-year history of progressive bilateral groin pain, right worse than left. She was seen a year prior for an avulsion fracture of her right anterior superior iliac spine sustained while running. She reports that her current pain seems to have started since that injury, but that it feels somewhat different in character than it did initially. Her pain is worse with upright activities, including just walking and climbing stairs. She has become quite limited and often lies down on the floor in pain after a long school day. Standard anti-inflammatories are no longer helpful.

On physical examination, NK has excellent range of motion in both hips and exhibits flexibility on the upper range of normal. Her baseline pain is exacerbated by extension and external rotation of the right hip. MRI of the right hip demonstrates a tear in the labral cartilage surrounding the acetabulum. An intra-articular injection of local anesthetic produced a week of symptom relief before the pain returned. Her anteroposterior (AP) radiograph of the pelvis is shown at right.

What is her diagnosis, and what is the definitive treatment for this condition?

Congratulations to Joel Friedlander, DO, MA, of Aurora, Colorado, who sent in the first correct answer to last issue’s challenge. The correct answer was achalasia, the subject of this issue’s cover story.