Pained
Musculoskeletal System
0
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S18_F2.jpg"}},{"insert":"\n\n"},{"insert":"Another mundane Friday evening at the orthopedics department is drawing to a close. You\u0027re watching the clock count down the minutes when the receptionist announces a new patient.\n\nTraveling to the consultation room, you find a medical student waiting outside.\n\n\u0022Good afternoon, Doctor. I\u0027m doing my orthopedics rotation and I\u0027ve been assigned to shadow you for the next couple of weeks\u0022, he explains.\n\nYou are pleased to have him, but at that same time, wonder whether having a student asking questions and hanging onto your every word will complicate things.\n"}]}
1
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S18_F3.jpg"}},{"insert":"\n\n"},{"insert":"You walk into the consultation room to see the patient leaning on the side of the exam table. He greets you, and while remaining in the same position, quickly starts saying why he is at your clinic.\n\n\u0022I\u0027ve had this pain in my right hip for a long time now,\u0022 the patient says. \u0022I tried to ignore it but it\u0027s starting to really bother me. I tried some over-the-counter stuff, but they don\u0027t seem to help much.\u0022\n\n\u0022Alright,\u0022 you say, \u0022let\u0027s start from the beginning.\u0022\n\nYou entice him to tell you his name and give you some further information on his condition.\n\n\u0022I\u0027m Bernard! Nice to meet you, Doctor,\u0022 he says and proceeds to tells you more about his hip pain, which is evidently giving him quite a hard time.\n"}]}
2
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S18_F5.jpg"}},{"insert":"\n\n"},{"insert":"You learn that the pain began 6 months ago, was unrelated to trauma or any specific event, and has progressed since. It is constant and dull with no radiation, is worse on walking, and is slightly alleviated by resting and after taking over-the-counter analgesics. He rates it as 7\/10 on the pain scale.\n\nThe other hip and both knees are not painful, and no other symptoms are present.\n"}]}
3
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S18_F3.jpg"}},{"insert":"\n\n"},{"insert":"You also learn that Bernard is 32 years old, works as a copywriter, and is not known to suffer from any chronic diseases. His family history is also unremarkable.\n\nHe does, however, admit to being a \u0022whiskey after work kind of guy,\u0022 drinking up to 3 glasses before bed, several times a week. He also has a 10-year history of smoking around 10 cigarettes per day.\n\nBernard is not on any medications and denies using recreational drugs. He does not exercise regularly, but claims to have been trying to watch his diet lately. His BMI is 28 kg\/m2.\n\nHe has no known allergies.\n"}]}
4
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S18_F8.jpg"}},{"insert":"\n\n"},{"insert":"Inspection of the relevant joint is negative for erythema, visible swelling, or bruising. On palpation of the affected hip there is no warmth or localized tenderness. Both passive and active ranges of motion are slightly restricted, but resisted movements are normal. Sensation is intact. The femoral pulses are normal, and there is no inguinal lymphadenopathy.\n\nYou perform a few tests to further your understanding of his symptoms. The log roll test of the right leg elicits pain in both directions, while the FADIR test reveals limitation and pain on internal rotation. The FABER test is normal. The Thomas test reveals no fixed flexion deformity, while the straight leg raise test (SLRT) provokes pain at 65 degrees.\n\nThe remainder of the examination reveals no other abnormalities.\n"}]}
5
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S18_F3.jpg"}},{"insert":"\n\n"},{"insert":"You ask Bernard to walk so that you can observe his gait.\n\nWhen doing so, he swings his body excessively to the right to compensate for a left hip drop. You also notice a slight elevation of the left hip during the stance phase of the right leg.\n"}]}
6
{"ops":[{"insert":"As you make these observations, the medical student standing at your side asks you discreetly, \u0022Doctor, what\u0027s that gait abnormality?\u0022\n\nYour answer is:\n"}]}
1. "The Trendelenburg gait"
2. "A coxalgic gait"
3. "An antalgic gait"
8
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9
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10
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7
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