Author: Karen Frye, DO
Co Author #1: Karen Frye D.O.
Co Author #2: Michael Reeder, D.O.
Editor: Margaret Gibson, MD
A 65 year old active male presented to our clinic with worsening right low back and buttocks pain, right anterior medial hip pain and pain that radiated down his anterior thigh to his knee.
The patient is very active and works out regularly. He participates in recreational ice climbing and is involved with search and rescue. He has a history of DJD of the lumbar spine and hip for which he has been seen for the past 5-7 years. He denied any recent trauma, falls or injury. The pain had worsened over the past 2 months. He reported the pain was worse with hip flexion and external rotation, worse after sitting for prolonged time and with rising from sitting to standing. The patient was able to do the elliptical without pain, but it hurt afterwards. He denied any numbness or tingling in his lower extremities, no bowel or bladder dysfunction, no saddle anesthesia, no fever or chills, and no weight loss.
Gen: Pleasant 65 year old male, alert and oriented, no acute distress.
Back: Forward flexes to 3 inches from the floor. Extension and side bending are easy without pain. Some TTP over right SI joint and right gluteus maximus. Negative straight leg raise.
Hip: Not tender to palpation over greater trochanter. Tenderness in right medial groin with flexion, external & internal rotation of the hip. + Pain with FABER test. Limited ROM with figure of four bilaterally, R>L. Some discomfort with Thomas test in extension on right. Negative log roll. Normal pulses, no masses.
Knee: No effusion, normal ROM, negative Lachmanís & posterior drawer. No pain or laxity with varus or valgus strain
NV: Walks with non-antalgic gait, able to heel/toe walk without difficulty. Strength 5/5 bilaterally. DTRís 2/4 without clonus. Sensation intact and equal bilaterally.
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