A ballet dancer with chronic hip pain due to a lesser trochanter bony avulsion: the challenge of a differential diagnosis

Physical therapy assessment involves confirmation of a medical diagnosis. To help discuss this process, this case report is presented regarding a ballet dancer who experienced 6 years of chronic hip pain and dysfunction. Many diagnostic tests and surgical procedures were performed by various physicians in search of a diagnosis. Physical therapy assessments did not support the working diagnoses, and treatment given according to evaluation findings was not effective. Initial hip radiographs revealed a bony ossicle at the lesser trochanter, which was overlooked. Hip radiographs taken 5 years later revealed the same bony ossicle. Ultimately, surgical removal of the ossicle eliminated the hip pain, and the patient returned to full activity and dance again. With the attempt to confirm the patient's diagnosis, the physical therapy approach to problem solving is discussed. This case gives an example where it is important to question the physician's diagnosis when the physical therapy assessment and treatment response do not support it. it is also evident that an in-depth physical therapy assessment may be self-limiting if pathology has not been ruled out properly by the physician.