Case:Leg Pain 001: Difference between revisions
From WikiMSK
No edit summary |
No edit summary |
||
Line 2: | Line 2: | ||
70 year old man with a one year history of exertional left lower limb pain, referred to you for consideration of a left hip corticosteroid injection. | 70 year old man with a one year history of exertional left lower limb pain, referred to you for consideration of a left hip corticosteroid injection. | ||
The pain is exertional in nature with no pain at rest. It started a year ago insidiously. The pain starts in the left anterior groin, and then gradually works its way down the lateral hip and down the lateral aspect of the leg and foot. The lower limb also getting progressively more numb. it comes on after 30 metres but it is inconsistent. If he rests then goes away after 5-10 minutes. Prolonged standing is normally ok. The pain comes on especially with hills but even walking around the supermarket. | |||
The pain | |||
He been seeing a physiotherapist for the pain who has been giving him exercises and go him going on an exercise bike, but he finds the exercises uncomfortable. | He been seeing a physiotherapist for the pain who has been giving him exercises and go him going on an exercise bike, but he finds the exercises uncomfortable. | ||
Line 10: | Line 9: | ||
He does not have any current back pain. | He does not have any current back pain. | ||
'''Previous Imaging''' | |||
The referring doctor previously organised the below x-ray of his pelvis and hips | |||
<gallery mode=packed heights=200px> | |||
File:Leg pain case 001 pelvis AP.png | |||
File:Leg pain case 001 L hip lateral.png | |||
</gallery> | |||
{{Collapsible textbox | |||
|title=Pelvis and Left Hip Radiograph Report | |||
|text= There is slight cartilage space narrowing posteromedially in both hips not associated with any marginal spur formation. Cartilage space is preserved superiorly. Remainder of the bony pelvis and the sacroiliac joints are normal. | |||
}} | |||
<br> | |||
'''PMHx''' | |||
*Heart failure with preserved ejection fraction | *Heart failure with preserved ejection fraction | ||
*Hypertension | *Hypertension | ||
*Hyperlipidaemia | *Hyperlipidaemia | ||
'''Social history''' | |||
*He is still working at 70, retired 4 times. He does sedentary accountancy type work. | |||
*Ex-smoker | *Ex-smoker | ||
=Examination= | |||
*Gait normal | |||
*Spine range of motion grossly normal | |||
*No lower limb wasting, tone, power, reflexes, sensation normal | |||
*Slump test and straight leg raise negative | |||
*No tenderness over the lateral hip abductors | |||
*Mild left groin tenderness | |||
*Hips: Internal rotation 10 degrees, external rotation 30 degrees, equal bilaterally | |||
*Springing over L5/S1 segment causes shooting pains down the right leg (contralateral limb to symptoms) | |||
=Imaging 1= | =Imaging 1= | ||
Line 52: | Line 62: | ||
no spinal tenderness | no spinal tenderness | ||
=Follow Up= | =Follow Up Visit= | ||
Here for ABPI measurement | Here for ABPI measurement | ||