Chronic Thigh Pain in a Young Adult Diagnosed as Synovial Sarcoma: A Case Report.

Synovial sarcoma is a slow-growing, intermediate- to high-grade neoplasm with extensive metastatic potential. Accurate diagnosis of synovial sarcoma may pose a challenge to providers because of its indolent growth and variable presentation. The findings of a soft-tissue, periarticular mass with calcifications in a young patient are highly suggestive of synovial sarcoma. Although different imaging modalities can aid in the diagnosis of synovial sarcoma, diagnostic certainty is typically only confirmed by biopsy and histologic analysis. We present a case describing the diagnostic workup of synovial sarcoma with an emphasis on imaging findings in a patient with increasing symptomatology spanning more than a decade. LEVEL OF EVIDENCE: V.

Clinical presentation of patients with symptomatic anterior hip impingement.

Femoroacetabular impingement (FAI) is considered a cause of labrochondral disease and secondary osteoarthritis. Nevertheless, the clinical syndrome associated with FAI is not fully characterized. We determined the clinical history, functional status, activity status, and physical examination findings that characterize FAI. We prospectively evaluated 51 patients (52 hips) with symptomatic FAI. Evaluation of the clinical history, physical exam, and previous treatments was performed. Patients completed demographic and validated hip questionnaires (Baecke et al., SF-12, Modified Harris hip, and UCLA activity score). The average patient age was 35 years and 57% were male. Symptom onset was commonly insidious (65%) and activity-related. Pain occurred predominantly in the groin (83%). The mean time from symptom onset to definitive diagnosis was 3.1 years. Patients were evaluated by an average 4.2 healthcare providers prior to diagnosis and inaccurate diagnoses were common. Thirteen percent had unsuccessful surgery at another anatomic site. On exam, 88% of the hips were painful with the anterior impingement test. Hip flexion and internal rotation in flexion were limited to an average 97 degrees and 9 degrees, respectively. The patients were relatively active, yet demonstrated restrictions of function and overall health. These data may facilitate diagnosis of this disorder.

Hip joint pain referral patterns: a descriptive study.

OBJECTIVE: To determine hip joint pain referral patterns. DESIGN: Retrospective analysis. Setting. Multicenter. Patients. Fifty-one consecutive patients meeting clinical criteria of a symptomatic hip joint. Interventions. Fluoroscopically guided intra-articular hip joint injection. Outcome Measures. Anatomic pain map before hip injection and visual analog scale both before and after hip injection. RESULTS: The hip joint was shown to cause pain in traditionally accepted referral areas to the groin and thigh in 55% and 57% of patients, respectfully. However, pain referral was also seen in the buttock and lower extremity distal to the knee in 71% and 22%, respectively. Foot and knee pain were seen in only 6% and 2% of patients, respectively, while lower lumbar spine referral did not occur. Fourteen pain referral patterns were observed. CONCLUSIONS: Buttock pain is the most common pain referral area from a symptomatic hip joint. Traditionally accepted groin and thigh referral areas were less common. Hip joint pain can occasionally refer distally to the foot. Lower lumbar spine referral did not occur.