54 Year Old Tennis Player With Crippling Right Thigh Pain - Page #1

Author: Jacob Erickson, DO
Co Author #1: Gregory Garrison, MD

Patient Presentation:
A 54 year-old tennis player admitted to the hospital service with the inability to walk due to crippling right thigh pain. Pain has been present for over six months. Pain started anteriorly near the right knee, now extending proximally towards the right hip. Rates pain 10/10 at presentation. Has been in a wheelchair for the past two months. She has been working with multiple specialists in the outpatient setting and working towards bilateral knee replacements. Review of symptoms is negative for fever, chills, upper extremity weakness or recent vision change.
photo 1

MRSA cellulitis in 2010 involving right buttocks
Jones fracture
Severe bilateral PFPS

Physical Exam:
General: Moderate distress, writhing around bed in pain
-Inspection: Gross atrophy of right thigh. Normal tone and bulk of upper extremities. Right knee held in partial flexion.
-ROM: Unable to actively extend right knee from flexed position. Passive extension of knee to 150 degrees with significant pain. Flexion/Extension of right hip not assessed due to patient discomfort on initial exam.
-Palpation: Moderate tenderness with deep palpation of right sided anterior and posterior thigh musculature. No low back tenderness.
-Special testing: Gait not assessed. Contralateral straight leg raise negative. Unable to perform other tests given significant pain.
-Neuro: Decreased right L4. Left L4 2/4. L5, S1 are are 2/4 bilaterally. Sensation grossly intact to light touch in L2-S1 dermatomes bilaterally. Babinski with up-going toes bilaterally.

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