[76F] Experiencing hip pain post-fall with a history of multiple joint surgeries
Patient Description
A 76-year-old female reports severe hip pain that started 10 days ago after a fall, with the pain localized more to the side of the hip. The pain intensity varies, with no pain at rest but escalating to excruciating levels upon hip flexion. The patient has a complex medical history, including multiple joint surgeries such as knee replacement, wrist reconstruction, shoulder rotator cuff repair, and two laminectomies. She has been diagnosed with Psoriatic arthritis since 2015 and Ménière’s disease since 2028. Known allergies include penicillin and several other unspecified antibiotics. Current medications consist of thyroid replacement, lisinopril, prevastatin, turmeric, Tylenol (noted as ineffective for current hip pain), a multivitamin, fish oil, and vitamin D3. The patient is accustomed to walking 3-4 miles daily but is currently unable to do so due to the pain. The importance of maintaining mobility is acknowledged, and the patient expresses a strong desire to continue being active.
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Arora's Assessment
Hip Pain
Differential diagnosis
- Given the recent history of trauma, the most likely diagnoses are hip fracture (S72.0), hip dislocation (S73.0), or hip contusion (S70.01).
- Given her history of psoriatic arthritis, exacerbation of her arthritis (M06.272) is also a possibility.
- Less likely but possible given her symptoms are hip bursitis (M70.5) or hip sprain (S73.1).
Plan
Perform a physical exam of the hip, assessing range of motion and pain. Order an X-ray of the hip to evaluate for fracture or dislocation. If the X-ray is negative but the pain persists, consider ordering an MRI to evaluate for soft tissue injuries. Continue with Tylenol for pain management, and consider adding a nonsteroidal anti-inflammatory drug (NSAID) if not contraindicated. Physical therapy may be beneficial for strengthening and improving mobility.
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1 yr ago
