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An Unusual Case Of Atraumatic Thigh Pain - Page #1
 

Author: Cher Chang, MD
Co Author #1: Rajiv Jain, MD
Senior Editor: Drew Duerson, MD
Editor: Moira Davenport, MD

Patient Presentation:
60 y/o Caucasian male with PMH GERD, hyperlipidemia and eczema was seen at the orthopedic urgent care clinic for evaluation of right groin pain that started 2 weeks prior.

History:
Patient was moving multiple boxes up and down steps at his dad's house prior to the onset of groin pain. He notes pain over the mid-medial right thigh. He was having pain when moving from sitting to standing and also noted pain while walking. Patient has been using ice, ibuprofen and a compression sleeve for pain and did notice slight improvement in his symptoms. He also started to use a cane to ambulate due to pain. No numbness paresthesia was reported. He denied any prior injuries to the groin. Patient denied fever or chills. The patient had been seen and evaluated by his PCP; x-rays of the right femur showed mild hip DJD but a normal femur. Venous Doppler ruled out a DVT but noted a probable muscle tear with hematoma or a possible mass. An MRI of his right thigh was ordered for further evaluation.

Physical Exam:
Vital signs on arrival are as follows:
T 36.9, HR 78, BP 124/76, RR 16, saturation 98% RA
Patient is awake, alert and oriented x 3 in mild discomfort
Abdomen: Soft, non-tender, non-distended
Back: No midline or paravertebral tenderness to the thoracolumbar spine
Extremities: Full ROM of all joints of the bilateral lower extremities, however right hip abduction and internal rotation increased his pain. Tenderness to palpation noted along the medial aspect of the right thigh. No bony tenderness noted.
Neuro: Strength 5/5 throughout with the exception of right hip flexion and abduction, which are 4+/5 and limited by pain. Sensation intact to light touch. Gait slightly antalgic to the right

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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