After few sessions, he felt some relief for short while, but the symptom recurred. He was then referred to sports medicine for trial of non-operative management with hip stretching and strengthening exercise. His MRI of Left hip confirmed the diagnosis of FAI with labral tear. History and clinical examination raised high index of suspicion of FAI, thus MRI hip was ordered. His neurological examination is similar from previous clinic review however, he was unable to perform straight leg test due to excruciating pain of left hip. His hip provocation test is positive, suggestive of Femoral acetabular Impingement (FAI). His left hip range of motion is limited especially in internal rotation. His weight is 82 kg with Body Mass Index of 25.9 kg/m 2. Clinically, he presented with antalgic gait and classical C Sign. His pain score is always 8 to 10 out of 10 with oswetry disability score of 33. His hip pain is aggravated by prolong sitting, after waking up from bed, and prolong standing. His hip pain is described as anterior hip pain, non-radiating different from sciatica pain that he felt before. However, in June 2018, he develops new symptom of acute excruciating left hip pain disabling him to perform his normal daily living activity. His back pain is well controlled with analgesic, his motor power is improving, his sensation is slightly better, and he is able to resume his daily activity and exercise in the gym as usual. His first Magnetic Resonance Imaging (MRI) Spine in 2015 showed left lateral disc prolapse at L2-元, 元-L4, L4-L5, and L5-S1 with nerve roots compression.Īfter multiple visit to physiotherapy and clinic review, his condition is improving. He was diagnosed with prolapse intervertebral disc in the past 7 years however his condition worsening for the past 3 years with multiple episode of severe back pain requiring admission and he develops reduces sensation over left lower limb at 元 and L4 dermatomes associated with reduced motor power in dorsiflexion of ankle and extension of big toe over left lower limb. He is an active in recreational body building exercise for 10 years with an athletic physique. Moreover, an algorithm that can be useful in diagnosing the hip spine syndrome is discussed, be useful in correct diagnosis and treatment of complex hip spine syndrome. The purpose of this case report is to present a young recreational body building athlete with a known case of lumbar pathology complaining of hip pain. This account for delay in diagnosing and giving treatment. The confusion of where is the primary source of pain often a headache to clinician when hip and spine pathology co-exist together. The hip spine syndrome often associated with hip arthrosis with degenerative spine disease, however, it should be considered in young athlete as well. The term "hip spine syndrome" referring to coexistent of both lumbar and hip pathology. Hip, Spine, Hip spine syndrome, Intraarticular hip injection A systematic approach is discussed in this report to guide physicians who manage cases of complex Hip Spine Syndrome. Post-operatively, there was a big improvement is seen in pain and disability outcome. Patient was then counselled for laminectomy. This led to the surgeon with the high index of suspicion that the pain was not arising from the left hip but from the spine. The pain did not resolve despite intra-articular injection. Patient was offered intra-articular anesthetic hip injection while planning for surgical intervention. His clinical examination revealed a classical positive finding of Femoral Acetabular Impingement (FAI) with positive hip provocation tests and MRI confirmed the diagnosis of acute left labral tear of the hip. This is a case of 32-years-old male, active body builder with herniated disc 元, L4 and L5 for 5 years presented with acute onset excruciating pain over the anterior portion of his left hip that was affecting his daily living. However, it can also present in young athlete as well. Hip spine syndrome is often associated with hip arthrosis and degenerative spine disease affecting the older generation.
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