A Unique Leg Injury in a Dancer

Deborah Cudnowski, MD
Peter J. Carek, MD, MS

THE PHYSICIAN AND SPORTSMEDICINE - VOL 30 - NO. 12 - DECEMBER 2002

A 19-year-old female college student reported bilateral anterior knee pain that she had had for at least 4 weeks. She denied any previous injury or precipitating event. The pain was exacerbated when she ascended and descended stairs, but she did not experience swelling or decreased range of motion in her knees. The pain did not compromise her daily activities and was absent at night. When she saw her physician, her sole activity was as a modern dancer; she danced several hours every day. She did not have a history of stress fracture, amenorrhea, or eating disorder.

On physical examination, the patient had full range of motion in both knees. No effusion or joint-line tenderness was present, but there was localized peripatellar tenderness. Tests for meniscal pathology or ligamentous instability were unremarkable. Plain radiographs of the knees were within normal limits (figure 1). An initial diagnosis of patellofemoral pain syndrome was made and conservative treatment instituted.

In several follow-up visits, the patient's pain persisted, and she continued to dance despite experiencing increasing discomfort. In particular, turning on her left leg during routines aggravated left knee pain, which had worsened markedly in comparison to her right knee. In addition, a pain located in the left distal lateral thigh had begun several days before her last visit. At that time, the pain had begun to interfere with her daily activities and severely limited her dance routines. Physical examination findings remained unchanged, and magnetic resonance imaging (MRI, figure 2) of the left knee was ordered.

What is your diagnosis? What conditions should be included in the differential diagnosis? What studies could offer additional diagnostic information about the distal thigh pain?

Dr Cudnowski is a family physician in Duluth, Minnesota. Dr Carek is associate professor and residency program director in the department of family medicine at the Medical University of South Carolina in Charleston. Address correspondence to Peter J. Carek, MD, MS, 9298 Medical Plaza Dr, Charleston, SC 29406; e-mail to carekpj@musc.edu.