A 78-Year-Old Woman with Right Hip Pain
OA is a 78-year-old woman who presented to the emergency department with complaints of right hip pain. She fell in her apartment 2 weeks prior to evaluation and although the pain was described as severe, she was able to ambulate with difficulty. Radiographs (Figs. 1,2) showed no evidence of an acute fracture. She was given oral pain medication and sent home. Because the pain persisted despite Extra Strength Tylenol and Motrin, the patient made an appointment with her private internist.
(Enlarge Image)
AP pelvis
(Enlarge Image)
AP, right hip
The patient has a long history of right hip pain dating from 1980 when she fell down a flight of stairs and sustained a right acetabular fracture. She was hospitalized, treated medically and discharged several days later. Over the past 17 years, her right hip pain has progressively worsened -- first forcing her to use a cane and eventually a walker.
Her past medical history is significant for hypertension and coronary artery disease and she suffered a myocardial infarction 30 years ago. Her only surgical procedure was a hysterectomy approximately 20 years ago. Her medications included furosemide, verapamil, amlodipine, nifedipine, digoxin, misoprostol, ibuprofen, and cyclobenzaprine.
Physical exam reveals an obese woman in no acute distress. The positive findings included a right hip flexion contracture of 20 degrees and a right knee flexion contracture of 20 degrees. She was tender to palpation over the greater trochanter and heel tap elicited severe right hip pain. The patient was unable to actively straight leg raise on the right, or rotate the extremity, both secondary to pain. Passive ROM yielded 10 degrees of internal and 10 degrees of external rotation with exquisite pain. No passive abduction or adduction was possible. She did not tolerate passive flexion of the hip. The neurovascular exam was normal.
Radiographic studies taken in the emergency department included an AP pelvis, AP and lateral views of the right hip (Figs. 1,2) and were negative for acute fracture.
Her internist ordered an MRI (Fig. 3) and the formal interpretation of the MRI revealed severe osteoarthritis, a nondisplaced fracture at the base of the femoral neck, and a possible healed acetabular fracture.
(Enlarge Image)
MRI of pelvis
To improve diagnostic accuracy, a CT scan (Fig. 4) was also ordered and revealed no fracture.
(Enlarge Image)
CT scan, right hip
What is the most likely diagnosis based on the history, physical exam, and radiographic findings?
View the correct answer.
<p>Advanced osteoarthritis of the right hip</p>
OA is a 78-year-old woman who presented to the emergency department with complaints of right hip pain. She fell in her apartment 2 weeks prior to evaluation and although the pain was described as severe, she was able to ambulate with difficulty. Radiographs (Figs. 1,2) showed no evidence of an acute fracture. She was given oral pain medication and sent home. Because the pain persisted despite Extra Strength Tylenol and Motrin, the patient made an appointment with her private internist.
(Enlarge Image)
AP pelvis
(Enlarge Image)
AP, right hip
The patient has a long history of right hip pain dating from 1980 when she fell down a flight of stairs and sustained a right acetabular fracture. She was hospitalized, treated medically and discharged several days later. Over the past 17 years, her right hip pain has progressively worsened -- first forcing her to use a cane and eventually a walker.
Her past medical history is significant for hypertension and coronary artery disease and she suffered a myocardial infarction 30 years ago. Her only surgical procedure was a hysterectomy approximately 20 years ago. Her medications included furosemide, verapamil, amlodipine, nifedipine, digoxin, misoprostol, ibuprofen, and cyclobenzaprine.
Physical exam reveals an obese woman in no acute distress. The positive findings included a right hip flexion contracture of 20 degrees and a right knee flexion contracture of 20 degrees. She was tender to palpation over the greater trochanter and heel tap elicited severe right hip pain. The patient was unable to actively straight leg raise on the right, or rotate the extremity, both secondary to pain. Passive ROM yielded 10 degrees of internal and 10 degrees of external rotation with exquisite pain. No passive abduction or adduction was possible. She did not tolerate passive flexion of the hip. The neurovascular exam was normal.
Radiographic studies taken in the emergency department included an AP pelvis, AP and lateral views of the right hip (Figs. 1,2) and were negative for acute fracture.
Her internist ordered an MRI (Fig. 3) and the formal interpretation of the MRI revealed severe osteoarthritis, a nondisplaced fracture at the base of the femoral neck, and a possible healed acetabular fracture.
(Enlarge Image)
MRI of pelvis
To improve diagnostic accuracy, a CT scan (Fig. 4) was also ordered and revealed no fracture.
(Enlarge Image)
CT scan, right hip
What is the most likely diagnosis based on the history, physical exam, and radiographic findings?
Advanced osteoarthritis of the right hip
Advanced osteoarthritis of the right hip and a femoral neck fracture
Advanced osteoarthritis of the right hip and an acute acetabular fracture
Advanced osteoarthritis of the right hip and degenerative lumbosacral spine disease
Advanced osteoarthritis of both the right hip and right sacroiliac (SI) joint
View the correct answer.
<p>Advanced osteoarthritis of the right hip</p>