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A 22 year-old college cross-country runner developed hip and groin pain that initially started while running, but is now painful when walking across campus. Radiographs show no evidence of a stress fracture, an alpha angle of 45 degrees, and a lateral center edge angle of 30 degrees. An MRI shows focal, intense marrow edema in the superior-lateral femoral neck. What is the most appropriate treatment?
Operative treatment with percutaneous screw placement
Hip arthroscopy with cam resection
Hip arthroscopy to treat both cam and pincer impingment
Non-operative treatment with NSAIDs and reduction in mileage
Non-operative treatment with partial weight-bearing
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A 24-year-old female marathon runner experiences gradual onset of right groin pain. Initially it was only painful during running, but now it is painful with walking. She has no mechanical symptoms and denies back or lower leg symptoms. On exam, she has pain when attempting a straight leg raise and with passive internal rotation of the hip. Pelvis and hip radiographs demonstrate normal acetabular version and normal femoral head-neck offset. What is the next most appropriate step in her care?
Intra-articular hip corticosteroid injection
Tapered oral corticosteroid dosing regimen for one week
EMG and nerve conduction studies
MR imaging of the hip
CT abdomen and pelvis to evaluate for sports hernia
A 20-year-old male marathoner has had left sided groin pain for the past 4 weeks. He has continued to maintain his routine running regimen despite the discomfort. Radiograph, bone scan, and MR images are shown in Figures A-D. What is the most appropriate next step in management?
Referral to orthopaedic oncologist
Valgus intertrochanteric osteotomy
Hip arthroscopic evaluation and labral repair
Percutaneous screw fixation
Irrigation and debridement with course of intravenous antibiotics