Diagnosis of trochanteric bursitis versus femoral neck stress fracture

This case report describes a 46-year-old male runner who reported the sudden onset of right hip pain. A diagnosis of trochanteric bursitis was established by a physiatrist, and the patient underwent two courses of physical therapy for moist heat, ultrasound, and exercise. Because minimal improvement was seen in the patient's pain level and gait limitations following physical therapy, a consultation was requested of a fellow staff member in the same physical therapy department, who is both a chiropractor and a physical therapist. The consultant felt that the absence of tenderness to deep palpation of the greater trochanter, the presence of a noncapsular pattern of restriction of the right hip, and the patient's nonresponsiveness to physical therapy warranted further investigation. A differential diagnosis of avascular necrosis, fracture, or a loose body was made by the consultant. Magnetic resonance imaging (MRI) testing ordered by the consultant indicated a nondisplaced, complete stress fracture of the femoral neck. The results of the consultation and the MRI testing were communicated to the referring physiatrist. The patient was referred to an orthopedic surgeon, who performed an open reduction and internal fixation of the right hip. The patient was ambulatory without an assistive device or weight-bearing restrictions 5 weeks after surgery.