Author: Harmeet Malhi, DO
Co Author #1: Dr. Dean Padavan MD
Co Author #2: Dr. Damion Martins MD
Senior Editor: Christian Fulmer, DO
Editor: Marc Hilgers, MD, PhD, FAMSSM

Patient Presentation:
Two day history of sharp non-radiating 10/10 localized left posterior hip and gluteal pain.

History:
57-year-old female. Past medical history of right subdeltoid calcific bursitis, left supraspinatus calcific tendinosis , vitamin D deficiency (taking 1000 IU vit. D daily), and hypothyroidism. The patient denied any trauma or sudden inciting injury mechanism prior to onset of her symptoms. Pain reported as 8/10 initially, with mildly improvement since onset. Pain is worse while seated, supine, and upon direct palpation to the left posterior gluteal region. The patient reported pain to be intractable and was limiting her ability to work. She denied any mechanical symptoms or swelling of her hip. She denied fevers, knee pain, numbness or tingling in the lower extremities, history of similar pain, or prior surgery.

Physical Exam:
Medical Exam:
Well appearing female in no acute distress.

Orthopedic exam:
Inspection: antalgic gait with no overlying skin lesions, erythema, or induration
Range of Motion: Full in all planes with mild left posterior gluteal pain at the end point of left hip flexion.
Palpation: acute pain upon palpation of the left proximal hamstring at its origin. No pain over greater trochanter or ITB, no pain with palpation of the lumbosacral or inguinal region.
Distal pulses, sensation, and LE reflexes intact
Strength: 5/5 throughout. Resisted hip extension and knee flexion painful.
Special tests: Negative provocative maneuvers included FABER, FADIR, log roll, Stinchfield, and Ober's

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