[75F] Experiencing severe leg pain

Leg pain

Differential diagnosis

• Given the patient's age and the nature of her symptoms, the most likely diagnoses are osteoarthritis (M19.072), sciatica (M54.3), and peripheral vascular disease (I73.9).
• Less likely but possible given the patient's history of a fall are fracture (S82.2), ligament tear (S83.2), and bursitis (M70.6).

Plan

Perform a physical exam of the affected leg, focusing on the knee and hip joints, as well as the lower back. Order an X-ray of the hip and knee to assess for osteoarthritis or any other structural abnormalities. Consider ordering a Doppler ultrasound to evaluate for peripheral vascular disease.

For pain management, recommend continuation of heat or ice application and over-the-counter analgesics as needed. If the pain persists or worsens, consider prescribing a stronger NSAID or a trial of physical therapy.

Knee pain

Differential diagnosis

• Given the patient's history of a fall and the location of her pain, the most likely diagnoses are meniscus tear (S83.2), ligament tear (S83.2), and osteoarthritis (M19.072).
• Less likely but possible given the patient's symptoms are bursitis (M70.6), gout (M10.9), and rheumatoid arthritis (M06.9).

Plan

Perform a physical exam of the knee, focusing on range of motion, stability, and areas of tenderness. Order an X-ray of the knee to assess for osteoarthritis or any other structural abnormalities. If the X-ray is inconclusive and the pain persists, consider ordering an MRI to evaluate for soft tissue injuries such as a meniscus or ligament tear.

For pain management, recommend continuation of heat or ice application and over-the-counter analgesics as needed. If the pain persists or worsens, consider prescribing a stronger NSAID or a trial of physical therapy. If a meniscus or ligament tear is confirmed, refer to an orthopedic surgeon for further evaluation and possible surgical intervention.