A 45 year old female came with C/O pain in left hip since 4 months

 Feb 22, 2023

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Name: Manvitha (intern)

A 45 years old female came with C/O left hip pain since 4 months 

HOPI

Patient was apparently asymptomatic 3 years back then she had an alleged history of fall in rain and injured her left hip. The pain subsided on its own During past 4 months she is complaining of dragging type of pain radiating to left hip to left ankle not associated with any tingling sensation.

Swelling present 4 months back which subsided on its own 

No swelling present now 

No tenderness, calf tightness present

Pain aggravates during the walk, no relieving factors

No H/O Fever, joint tenderness, decreased range of movements


Past history 

N/K/C/O HTN, DM, epilepsy, asthma ,TB

Past surgery: undergone casesaerean section 11 years back


Personal history 

occupation house wife 

appetite normal 

diet non veg 

bowel and bladder movements normal

no addictions 

family history insignificant


Menstural history 

age of menarche 13 years 

regular 5/30 day cycle 


General examination 

patient is conscious cooperative coherent well oriented to time place person 






















No pallor, icterus, cyanosis, clubbing, lymphadenopathy, pedal edema 

Vitals 

temperature : 98 F

PR: 95 

RR:16cpm 

BP 110/80mmhg 

spo2: 98 at room air 


Systemic examination 

CVS S1S2 heard no cardiac murmurs heard 

RS NAD NVBS heard 

P/A Soft and non tender scaphoid abdomen 

No tenderness 

No palpable mass

Hernial orifices normal

No free fluid

No oragnomegaly

CNS : 

On day of presentation

Sensory 

Spinothalamic tract   

 Crude touch                            Right          Left

Upper limb                             Normal        Normal

Lower limb                             Normal       Normal 

Pain

Upper limb                            Normal          Normal 

Lower limb                            Normal          Normal 

Temperature 

Upper limb                            Normal          Normal 

Lower limb                            Normal          Normal 

Posterior column

Fine touch

Upper limb                            Normal          Normal 

Lower limb                            Normal          Normal 

Vibrations

Upper limb                            

Acromian                             7 seconds      6.3 seconds

Olecranon                            5 seconds      5 seconds

Lower end of radius             5.8seconds     6 seconds


Lower limb

Tibial tuberosity

Lower limb                          6.66 seconds      5.8 seconds    

Medical malleous                  5 seconds      5 seconds


Cortical 

Tactile localisation

Upper limb                            Normal          Normal 

Lower limb                            Normal          Normal 

Graphesth

Upper limb                            Normal          Normal 

Lower limb                            Normal          Normal 

Stereognos 

Upper limb                            Normal          Normal 


CNS

meningeal signs absent

Higher motor functions: conscious, coherent, cooperative, well orinted to time place person

Motor

Lower limb weakness

Hip                                Right          Left 

Flexion
Iliopsoas.                     4+/5.           4+/5
L1,2,3

Adductor femoris 
L5S1.                         4+/5.             4+/5

Gluteus medius 
And minimus 
L2L3.                         5/5.                 5/5

Gluteus maximis
L5S1.                         5/5.                 4/5

Thigh and  knee
L4S1 hamatring.        4+/5.              4+/5
L3L4 Quadriceps       4+/5.              4+/5

Leg and ankle
Tibialis anterior         4+/5.              4+/5
L4L5

Tibialis posterior
L4.                           4+/5.              4+/5

S1 EDB.                  4+/5.               3/5

FDL
S1S2.                      5/5.                3/5

EHL
L5S1.                      5/5.                  5/5

EDL
L5.                          5/5.                 3/5


Reflexes. 
       B.        T.         S.       K.      A.   P 
  
Rt.  ++       ++       ++.   +++    ++.  F
Lf   ++.      ++.       ++.   +++.   -      F

Single leg raising fest 
Left limb pain when raised at 75 degree
Right limb normal
Schobers test :18cm on bending 
 








Provisional diagnosis 

L5S1 left paracentral disc extrusion with left S1 nerve root compression with left extensior hallucinations weakness D6 hemangioma


Investigations











Treatment

                   





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