Forty-two-year-old Russell McCoy was energized and sweaty as he finished a three-mile run around his neighborhood. He headed straight for his refrigerator and cracked open a diet soda, downing it in a couple of swigs. Holding the empty can, he backed toward the garbage pail, pivoted, shot, and scored. Then pain, sudden and excruciating, lanced through his left hip. He bent over, aware that he had twisted something the wrong way. Breathing deeply, he felt a little better. A few hours later, though, he tried to run a few strides and almost yelped from the pain. For the next two weeks, he took it easy. But the hip didn’t get better.
I first saw Mr. McCoy in June, two months after the soda-can episode. He had already been to another doctor, who was convinced this was “referred pain”—in other words, pain in one body area that is actually the result of a problem in another. According to that doctor, Mr. McCoy had strained his lower back muscles and was experiencing it as hip pain. A week of an anti-inflammatory medicine and stretching exercises for the lower back had not helped, however. An X-ray of the hip a month later showed no sign of arthritis or fracture, and an MRI of the lower back hadn’t revealed much either, just a small disk bulge that seemed unrelated to the pain.
Over the two months since the injury, my patient told me, he had gained 10 pounds. He wasn’t exercising because it hurt too much. He wasn’t sleeping well, either; the hip ached when he lay on his left side. He sucked his breath in sharply when I pushed on the greater trochanter, the bony outer part of his upper left thigh.
