Thigh Pain in an 18-year-old Man

Excerpt

An 18-year-man presented to a tertiary orthopaedic oncology referral center with a 1½-year history of right thigh pain. He had no history of trauma or constitutional symptoms such as fevers, chills, or night pain. He described the intensity of pain as unchanged since its onset; it occurred mainly with walking or physical activity and was improved with the use of NSAIDs. Previous treatment with physical therapy resulted in no improvement. His medical and surgical histories were noncontributory. There was no family history of medical illnesses; in particular there was no history of cancer or other musculoskeletal diseases. On physical examination, he was a well-appearing man in no acute distress. He ambulated with an antalgic gait favoring the right leg. Musculoskeletal examination revealed his right lower extremity to have normal neurologic and vascular findings. No palpable mass or localized area of tenderness was present, and ROM of the hip and knee were normal. Radiographs (Fig. 1) and MRI (Fig. 2) were obtained. The remainder of his examination and complete blood count and inflammatory markers were normal.

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