M9) Progressive chronic hip pain

Review the Learning Outcomes, Hx, PE and Labs, and begin the module with your Provisional Diagnosis. Keep hitting "Next" to move through the module.

Learning Outcomes

  1. Articulate your relationship with the consulting diagnostic radiologists in the evaluation of a patient with joint pain.
  2. Review the DDx considerations in a patient with joint pain.
  3. Identify the spectrum of imaging findings in appropriate modalities for evaluating patients with joint pain.


Physical Exam

Provisional Diagnosis

Select the Dx you believe is most appropriate
This patient with risk factors of older age and obesity presenting with decreased range of motion of the right hip, pain with increased weight bearing, and antalgic most likely has osteoarthritis. A hip fracture or dislocation is less likely considering the lack of history of trauma, gradual onset of symptoms, and ability to bear weight.
Well done. You were correct

Potential Acuity

What is your assessment of the likely acuity for this patient?

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The patient requires routine workup.

First Imaging Study

What is the first imaging study you will order?

X-ray is the best initial evaluation for bony or joint space abnormalities.
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Pertinent Imaging Observations

Click on the links below to view images from the study, and assess these key findings as best you can.

Watch our video

View the full study if you'd like to take a look yourself.

Second Imaging Study

What is the next imaging study you will order?

The findings are confirmed with the X-ray.
Well done. You were correct

What is your Diagnosis now that you have seen the imaging results?

The patient’s clinical presentation and findings are consistent with a diagnosis of osteoarthritis.

Current Acuity

Initially, you selected and we suggested acuity.

Has your concern for this patient changed?

The patient requires routine workup and management as their condition is not immediately life or limb threatening.

Assessment and Plan

Please provide your assessment and plan for this patient

This patient is presenting with severe osteoarthritis of the right hip. They will be referred to a physical therapist and prescribed NSAIDs. The patient should also undergo dietary and exercise counseling for weight loss. If they fail a trial of conservative therapy, they will be referred to an orthopedic surgeon who specializes in joint replacement.

Lessons Learned:
- Risk factors for osteoarthritis include older age, obesity, and previous joint injury.
- Patients usually present with progressive pain that worsens with increased weight bearing throughout the day.
- The disease is progressive and gets worse over time and cannot be reversed. However, different treatments options can be utilized to try to slow the progression.
- Radiographs are a good initial imaging modality.
- Findings on radiographs include joint space narrowing, subchondral sclerosis, subchondral cyst formation, and osteophytosis.

Socioeconomic Factors: Even after adjusting for risk factors, those who are with lower education and in nonprofessional lines of work have been found to have increased prevalence of and morbidity from osteoarthritis.

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