Just looking for some ideas for treatment / things to evaluate Patient has insidious onset of bilateral hip pain. Pain is severe, in area of greater trochanter and ITB, although only to mid-thigh. Patient also developed drop foot on right, with ankle pain on right. This was three weeks ago, and since this time patient has had course of corticosteroids, which improved symptoms but did not eliminate them. Drop foot is slowly improving and pain intensity is improving, but still present. Worse in the mornings and after sitting. Worse with sit to/from stand transitions. Pain-free when sitting and static standing. Pain with hip IR/ER in supine and standing but not prone. No low back pain, symptoms do not change with lumbar or sacral ROM or palpation. Tender to palpation bilateral lateral hips. MRI and xray to lumbar spine, hips, and sacrum unremarkable. Any ideas as to pathology or treatment? Have tried hip, lumbar, and sacral mobilizations, SI compression, distraction, and hip stabilization without symptom modification. Patient works a manual labor job.
You can do all the treatments that you can think of and I'm sure that it'll help, but this is a sudden condition that must be properly diagnosed. The next steps for the Doctors will be ordering a nerve conduction study, an MRI of the brain, followed up by a spinal tap, and then genetic testing. I would think that some of these tests will give the answers, but if not then this remains a bizarre case. If a Neurologist cannot find the answers then you will have to send them to a Rheumatologist.
< Message edited by CardioFlex Therapy -- April 9, 2018 9:32:46 PM >
That will be a good order of things. Obviously this is a neuro case, which could be a nerve entrapment but it's unlikely. It could be MS or another neuro genetic disorder so the MD will have to order each test until the answers become more clear. If all the tests are inconclusive then a spinal tap can be ordered. Lastly, genetic testing could find neuro diseases if all else fails to find it.
Joined: February 27, 2005
Next to iatrogenic disease, the next order of failures by hospital based doctors of medicine, is the over zealous use of electronic and intrusive testing, where false positives abound and otherwise easily defined ordinary problems, are considered to be rare examples of extraordinary pathology till proven otherwise. This is often the result of a mindset stemming from time spent in the A and E , where catastrophes are the order of the day and those with their hands on the wheel are often those with the least experience . Doctors of medicine are often good at internal med, their thinking is well aligned to livers, kidneys and hearts, but fail miserably when it comes to musculoskeletal probems.