Authors: James Condren / Editor: Steve Corry-Bass / Reviewer: Ciaran Mackle / Codes: IC2, IC6, IP1, MuP2, SLO1 / Published: 23/06/2020
A 79-year-old woman presents to the Emergency Department (ED) with a four day history of worsening non-traumatic left hip pain and is now unable to bear weight on the affected side. She has had associated fevers and rigors but denies any other symptoms.
Her past medical history includes Atrial Fibrillation and a wide local excision and radiotherapy for breast cancer many years ago.
On examination, she is unable to bear weight, is tender over her left inguinal ligament and has reduced range of movement in all planes due to pain. There is no focal bony tenderness, no cellulitic changes and no difference in limb length or circumference.
Observations are normal and she is afebrile.
Her admission bloods are grossly unremarkable with the exception of a CRP of 340mg/L (normal <5mg/L).
XR of her left hip shows chronic degenerative change but no acute abnormality.
Despite adequate analgesia, she remains unable to weight bear.
9 responses
Locally our protocol is not to do CT Pelvis/hip but go to MRI Pelvis/hips as it is more sensitive than CT at picking up occult hip fractures and other causes of painful weight bearing. Obviously not something that can be done in every department/hospital.
interesting topic- very likely to be missed
good case
Very interesting case.
Good read.
Saw a similar case recently
Very interesting with good key points for learning
Interesting case
Very interesting case. High potential to be missed or diagnosis delayed in view of MRI needed. Thank you for this good module