HISTORY: Patient is a 13 yo female pre-professional ballerina who developed pelvic pain during her training. She was doing an arabesque with her leg in single stance with the opposite leg extended. She then moved to a penché position with her torso leaned forward over a leg in single stance with her legs at 180 degrees. She felt an immediate pop in her left groin. She continued to dance through pain during 6 weeks of intensive ballet training prior to presentation to clinic. Pain described as 3/10, aching in left groin and buttock pain at rest. Pain better with rest and worse with walking, leg extensions and entrechant which is a vertical jump with repeated adduction of feet. She denied any numbness, tingling or weakness. Patient had no prior history of stress fractures, is not menstruating and eats a balanced diet.
PHYSICAL EXAMINATION: Tenderness to palpation over left pubic bone. Full pain free ROM in both hips. Special tests positive on the left side included FABER, FADIR, single leg hop and resisted adduction more than abduction. She had 4/5 hip abduction strength in side lying bilaterally.
DIFFERENTIAL DIAGNOSIS:
1. Ischiopubic stress fracture
2. Pubic apophysitis at adductor insertion
3. Femoral acetabular impingement
4. Hip labral tear
5. Ischiopubic synchondrosis with stress reaction
TESTS AND RESULTS:
Pelvis and hip AP and Dunn radiographs: There is a healing fracture of the left inferior pubic ramus, with a faintly visible fracture line and surrounding periosteal reaction.
MRI pelvis w/o contrast: Findings consistent with Asymmetric incomplete fusion of the ischiopubic chondrosis with stress reaction.
FINAL WORKING DIAGNOSIS:
Ischiopubic synchondrosis with stress reaction also known as Van Neck Disease
TREATMENT AND OUTCOMES:
1. Patient was made NWB on crutches for 2 weeks at her MRI follow up appointment.
2. At 2 week follow up patient had decreased pain to palpation over left pubic bone. She was progressed to WBAT, PT, no ballet for 6-8 weeks and continue with the sports nutritionist.
3. At 4 week follow up, patient had no pain on physical examination. Patient was progressed to return to barre class for 10 minutes for one week. She could increase her time each week as
instructed by her PT. Patient was not allowed to do speed work, jump or move her leg past 90 degrees in abduction, flexion or extension.
4. Patient will follow up in 6 weeks