Group 23: Matt Bersano, Tera Little, and Amber

Schoenicke

PTH 636: Exam and Diagnosis II

Case #6

A 70-year-old female enters your clinic with complaints of right anterior hip and anterior
thigh pain. She has been referred by her primary care physician (PCP) with a diagnosis of
"Right hip and thigh pain- PT eval and treat". She reports the insidious onset of pain began
approximately 10 months ago and has been slowly worsening since onset. She denies recent
diagnostic testing, non-positional night pain, bowel/bladder changes or unexplained weight
loss. Patient’s PMH is significant for diet-controlled diabetes mellitus (DM) and
hypertension (HTN). Her current medications include an unknown HTN medication and
Advil prn for pain. Additional signs and symptoms include:

 difficulty with putting on socks due to hip pain, ↓’d mobility and “stiffness”.
 ↑ pain with standing, extensive ambulation and lying prone.
 ↓ symptoms “almost immediately” with sitting and improved tolerance to ambulation
when leaning on a shopping cart at Meijer.
 Group 23: Matt Bersano, Tera Little, and Amber
Schoenicke

1. Please list the 3 or 4 MOST LIKELY working diagnoses.

 Osteoarthritis: Pt. is a 70-year-old with anterior hip pain, decreased mobility, and
stiffness, pt. has decreased symptoms with sitting and with unweighting self on the
shopping cart. Insidious onset (10 months)
 Femoral Acetabular impingement (FAI)/ Labral injury: anterior hip pain that refers
down the leg along with decreased mobility (pain with putting on socks)
 Tight Hip Flexors: pain with lying prone and excessive ambulation
 Femoral Nerve Injury/ Meralgia paresthetica: R anterior hip pain that is radiating
down the leg

2. What objective information do you feel would be important to collect during the examination of
this patient?
1. Observation/Visual Inspection/ General Appearance
- Any erythema or warmth around R hip in comparison to L hip
2. Posture
- Kyphosis: Could show presentation with OA due to flexed posture over a long period.
- Lumbar Lordosis/ Anterior Pelvic Tilt: if the pt. had tight hip flexors
3. Gait/ Transfer Assessment
- Look for the presence of Trendelenburg/Antalgic gait: pt. could be leaning toward the
side of pain to decrease the compressive forces at the hip with OA
- Assess bed mobility, and how pt. prefers to get out of the bed: pt. may prefer to role
onto her L side to push up
- Observe how pt. performs sit to stand, quality of motion: OA or tight hip flexors could
cause pt. to push up primarily with arms and L LE
4. ROM/ Mobility/ Muscle Length Testing
- Lumbar ROM: Reduction could present with impingement of femoral nerve root
- Hip ROM: Reduced external and internal rotation ROM is common with OA
- Thomas Test (MLT): rule in/out tight hip flexors and/or FAI
5. Strength Testing
- Trunk flexion/extension: checking for weakness above where the pain is presenting
- All hip strength: to check weakness with OA
- Knee Extension: to check for femoral nerve injury
6. Passive Joint Play
- Lumbar segmental testing (facet joint dysfunction causing pinching of femoral nerve)
- Hip IR and Ext before and after lateral distraction to check for comparable sign
(decreased pain with distraction could indicate OA)
7. Neurological Screen
- Lower Quarter Screen: to rule out femoral nerve injury/meralgia paresthetica
8. Palpation
- Right anterior proximal hip to assess iliopsoas; around R hip for tenderness to palpation
and any hypertrophy/atrophy
9. Special Tests
- Scours/grind test: Osteoarthritis pain
- FABER: could indicate iliopsoas spasms/ hypermobility
- FADDIR: rule in/out FAI/ hypomobility
- Anterior/Posterior Labral shear test: labral injury