Hey Doc, Why Can't I Walk? - Page #1

Author: Swami Rajaram, MD
Co Author #1: Vinu Verghese, DO
Senior Editor: Adam Lewno, DO

Patient Presentation:
A 77 year old male with a history of a left total hip arthroplasty (5 years prior) presented to the Emergency Department via EMS with progressive left hip pain for 1 day.

Per EMS, the left leg appeared internally rotated and shortened compared to the right. The patient denied any recent traumatic injuries, though notes that he went from a sitting to standing position frequently the day prior to presentation while running errands. Upon presentation he reported a constant left hip pain with radiation into his left thigh. He denied back pain, lower leg pain, numbness, weakness, urinary retention, saddle anesthesia or fevers. He reports that his pain had progressed to the point where he is unable to safely ambulate.

He did later report that he was on warfarin for a distant mechanical valve replacement.

Physical Exam:
Left leg:

Inspection - Does not appear shortened or rotated. No significant swelling of the hip, thigh or knee. No obvious discoloration.

Palpation - Compartments of the thigh feel soft. Tenderness to palpation along the gluteus medius and psoas muscles.

Range of motion - Passive flexion of the hip limited to 20 degrees due to pain. Active flexion of the hip fully limited. Flexion and extension at the knee and ankle full and painless.

Neurovascular - Normal sensation of the medial, anterior and lateral thigh. 2+ femoral, popliteal, DP and PT pulses.

Provocative testing - negative log roll test. Unable to complete FADIR or FABER testing due to limited hip flexion.

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.

© The American Medical Society for Sports Medicine
4000 W. 114th Street, Suite 100
Leawood, KS 66211
Phone: 913.327.1415

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