Disclosures: Mary E. Lynch, MD: Nothing to disclose

Case Description: An 8-year-old male wrestler with spastic right hemiplegic cerebral palsy experienced 3 weeks of left hip pain.

Setting: Physical medicine and rehabilitation consultation during inpatient hospital admission for constipation.

Patient: An 8-year-old male wrestler with a history of premature birth, spastic right hemiplegic cerebral palsy (Gross Motor Function Classification System Level I), attention-deficit/hyperactivity disorder, and chronic functional constipation complained of 3 weeks of atraumatic onset left lateral hip pain. He had no systemic symptoms. Weight-bearing worsened pain and NSAIDs improved it.

Assessment/Results: Gait was antalgic. Left hip abductor and flexor muscles were tender to palpation. Left hip internal and external range of motion was limited due to guarding. Examination was unable to differentiate between intra-articular and muscular cause. Differential diagnosis included early Leg-Calve-Perthes, slipped capital femoral epiphysitis, labral tear, and muscle strain. Left hip x-ray, CBC, and inflammatory markers were normal. Pelvis and left femur MRI demonstrated left greater trochanter apophysitis. He was unable to participate in physical therapy due to having a cecostomy tube placed. Symptoms resolved after 1 month of rest.

Discussion: The apophysis is a secondary ossification center that is subject to injury from repetitive stress. The calcaneus, tibial tubercle, distal patella, and iliac crest are common locations of apophysitis. The greater trochanter is a more rare location. Treatment of apophysis includes activity modification, ice, NSAIDs, and physical therapy. For this patient, overactivity was likely related to sports and overuse of his unimpaired limb. Fortunately, rest was all that was required to improve symptoms.

Conclusion: MRI of the left hip was necessary due to his unexplained pain with avoidance of weight-bearing, negative x-rays, and difficult physical exam. While rare, greater trochanter apophysitis is a condition that should be on the differential diagnosis for lateral hip pain in children and adolescents.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/greater-trochanter-apophysitis-in-an-8-year-old-boy-with-cerebral-palsy/