QUIZ: Hip pain followed by lumbar pain

Tuesday, 24 November 2009 21:17

Case description: A 62 years old woman is admitted to ER complaining of hip joint and lumbar pain. She states that she's suffering from coxarthrosis. A year ago, during an orthopedic visit, numerous osteofites and deformations were found. The patient was put on a list for a hip joint replacement. The date was set for December 2010. A week ago the patient went for a long walk to visit her communal garden and ever since the pain increased a lot. Asked about other symptoms the patient told the doctor that a week ago she's started feeling very weak and developed lumbar pain, which is why she came to the hospital. Currently her hip pain is mediocre.

Quiz questions: What additional questions should be asked? What do you suspect at a first glance?

Comments

0 #1 drmark15 2010-04-06 05:52

i suspect SCFE (slip capital femoral ephyphysis). Better to ask the patient if accidental fall happen to her. 62 year old woman, with hip arthritis, prone to accidental fall. Might be nerve compression of sciatic or MRI would confirm what nerve compresses.

0 #2 Mateusz Palczewski 2010-04-06 08:42

She haven't had any fall accidents. MRI is unavailable for two hours - what could you ask in the meantime? What laboratory tests should be ordered?

+1 #3 Ahmad qtaifan 2010-12-31 18:48

What about her urea level ?

0 #4 Mateusz Palczewski 2010-12-31 18:50

It's increased.

0 #5 veralupe22 2011-01-15 03:32

Hi. What about her weight?. Did she had any episodes of Gout?. Hyperuricemia has been related to avascular necrosis of the hips and femoral head. Could it be it?

0 #6 eleonora 2011-05-17 12:22

At a first glance the problem seems to be orthopedic. But the increased urea levels point to a whole new direction. I would ask for FBC, ESR, Calcium levels, AlP, serum and urine electrophoresis to exclude Multiple Myeloma. An X-ray of the lumbar region and the hip joint could also help exclude any orthopedic problem and would confirm osteolytic lesions in case of a myeloma. X-ray of the head might show a pepper-pot skull.

0 #7 Mateusz Palczewski 2011-05-17 17:33

She did not have gout.
FBC, ESR, serum electrophoresis , X-ray within normal.
Cannot make urine test because of anuria.
Calcium levels - decreased.
AIP - how would you diagnose it? What suggest AIP in this case?

Do you have more questions to patient now?

+1 #8 eleonora 2011-05-17 19:09

So our patient has renal failure? Any medications? Did she take NSAID for her hip? Any findings from PE? PTH?
Increased ALP could mean bone tumor if AST,ALT and GGT were normal.

0 #9 katia 2011-05-17 20:39

osteomalacia? ca level will decrease and ALP will increase.
anuria maybe due to an underlying kidney disease or kidney stone due to vit D toxicity.

0 #10 Mateusz Palczewski 2011-05-18 18:47

She was taking 10 NSAIDs each day because of her pain. Gratulations Eleonora that's right diagnosis!

What would you do with patient next?

PS. I am waiting for your cases Dears Users! :)