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An Uncommon Cause Of Chronic Knee And Hip Pain In A Refugee Patient - Page #1
 

Author: Dylan Quintana, MD
Co Author #1: Jaclyn Cooperrider MD CAQSM
Co Author #2: Joey Florence MD CAQSM
Senior Editor: Kristine Karlson, MD, FAMSSM
Editor: Katherine Fahy, MD

Patient Presentation:
A 41-year-old female refugee from Congo with a history of scoliosis and developmental hip dysplasia presented with 12 months of worsening chronic left hip and knee pain.

History:
The patient reported lower extremity weakness and pain since she was a young child with foot drop since grade school. She used a lower extremity brace in childhood but outgrew it in adulthood and had not replaced it. She denied a surgical history though noted history of anemia, hepatitis B infection, scoliosis and schistosomiasis. In the 12 months preceding her appointment, her left knee and hip pain and weakness had progressively worsened. She previously was ambulatory but had recently been required to use a wheelchair. Her pain was exacerbated in cold weather. She denied any recent or remote history of falls or trauma. She underwent one month of physical therapy prior to presentation without significant improvement.

Physical Exam:
Vitals: Within normal limits
General appearance: Patients appears to be in pain
Left lower extremity:
Inspection: Diffuse atrophy present across left lower extremity, . Left foot with pes cavus
Palpation: Diffusely non-tender to palpation, extremity cool to the touch below the knee
Range of Motion: Pain-free full range of motion of the hip with flexion, internal rotation, external rotation.
Strength: 5/5 hip flexion/extension/internal rotation/external rotation. 3/5 knee flexion/extension. 0/5 ankle dorsiflexion/plantar flexion
Sensation: Sensation to light touch intact throughout extremity
Reflexes: Absent patellar, soleus, gastrocnemius reflexes on left, Babinski negative, absent ankle clonus.
Gait: Poor balance, able to limp a few steps from wheelchair with L foot drop present
Vascular: 2+ left dorsalis pedis pulse

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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