HELP! Please help me diagnose this patient (Hip pain)

HELP! Please help me diagnose this patient (Hip pain)

Postby fiorello » Sat May 10, 2003 3:54 pm

:shock: 60 Y/O male with a progressive chronic pelvic/hip pain for ten years. I have ruled out any problems in lumbar/ L-S region. The most significant symptoms are the following: Pain in lateral hip and ischial Tub region is gradually provoke and will progressively become painful when the patient is walking on level surface and is worst when walking uphill or stairs. Pain usually starts after 1.5 minutes of continous walking with a normal cadence and stride length. Pain automatically gets abolish by sitting down. Any activities such as prolong standing, lifting or even digging(gardening) does not provoke the pain. Some tenderness noted bilaterally in greater trochanter region with max. manual pressure. No degenerative changes noted in both hips using an X-ray. I have taught of the following possible diagnosis 1) Coxa Plana or Legg-Calve'-Perthes 2)S-I or pelvic instability 3)Any arterial problem invoving hip joint and muscle around the pelvic and hip region. Thank you for any information.
fiorello
 
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Postby Regan » Sat May 10, 2003 4:10 pm

fiorello,

It is in my opinion that you can not rule in the Dx of Legg-Calve-Perthe's disease due to the fact that the age of onset occurs between 2-13 years of age. Your patient is 60 y.o. Characteristics of this Dx is a psoatic limp due to weakness of psoas major- therefore, the affected LE moves in external rotation, flexion, and adduction. Subjective c/o of gradual onset of "aching" pain at the hip, thigh and knee. Objectively you should notice AROM limited in abduction and extension. Radiographic findings provide evidence of postiive bony crescent signs.

Your patient seems to have increased pain with weightbearing activities such as walking up an incline and prolonged ambulation. These activities increase joint compressive forces at the hip secondary to gravity and muscular forces crossing that joint. Ever considering getting this patient on an aquatic therapy program? That might help. Just some additional thoughts to help your patient out...

-Regan Wong, MS, PT, CSCS
Strive! Physical Therapy Centers
http://www.striverehab.com
Regan
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Postby fiorello » Sat May 10, 2003 6:03 pm

Thank you for the quick reply.
fiorello
 
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Postby Regan » Sun May 11, 2003 6:26 pm

Fiorello,

Your welcome.

-Regan Wong, MS, PT, CSCS
Strive! Physical Therapy Centers
http://www.striverehab.com
Regan
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Postby fiorello » Thu May 15, 2003 3:40 pm

:? Regan, I really thank you for your input. There is definitely a weakness of psoas major but so as most of the major muscles of pelvic and hip region and weakness is very evident after walking. Patient's other signs include severe tightness I-T band which appears to have some degree of ossification and after patient walks approximately 1.5- 2minutes he starts to have a very pronounce waddling gait. I am considering more of a metabolic disease, maybe a form of muscular dysthropy especially Inclusion Body Myositis. Thank you and I really appreciate your input. More power to you!
fiorello
 
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Postby elenitak » Tue May 16, 2006 1:48 pm

Hi,
I hate to second guess you but these symptoms really look like a classic facet dysfunction. Can the patient perform LS extension in standing X 10 reps pain free? Have you tried L5-S1 manual distraction?
THis is one of the easiest manual therapy techniques which often offer immediate relief.
Good luck!
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anteriorly rotated innominate

Postby expatient » Wed May 17, 2006 9:01 am

Just check if other iliac has rotated anteriorly: Are PSISs leveled whith standing flexion test, sitting fexion test and when lying? If not, it is obvious: SIJD.
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