Brief History:
25 years old male, asymptomatic 5
months back, sustained injury in RTA about 5 months back, insignificant
impaction as pt returned to job immediately.
History of massage therapy for
initial one month.
Pain around left hip. Restricted hip
movements. Pain more in night, night cries present.
Unable to squat, sit crossed leg,
almost bed ridden since 1 month.
No history of swelling, discharge.
Weight loss +,decrease appetite +.
Brief positive finding:
On
general examination:
cachexic,malnourished anemic patient,uncomfortable due to
pain.
Unable to
bare weight on left lower limb(antalgic gait)
HIP EXAMINATION:
Inspection:
left
lower limb in 45 degrees flexed position.
Apparently
shortened limb.
Left ASIS
at higher level.
Scarpas triangle
is free.
Loss of
prominence over greater trochanter region.
Gluteal,thigh muscle
wasting present.
No scars
,sinuses,swellings,dilated veins or
pulsations.
Palpation:
No local rise of temperature,
ASIS at higher level at left side.
Joint tenderness ant and post.
Greater trochanter tender, relatively less prominent,poximally migrated,irregular,broadened.
Femur shaft nontender and normal.
Movement:
FFD: 45 DEGREES.
ADDUCTION DEFORMITY:10 DEGREES
EXTERNAL ROTATION:5 DEGREES
INTERNAL ROTATION:5 DEGREES
Measurements:
Apparent shortening 4 cms.
true shortening 2 cms.
2cms wasting of thigh muscles.
2 cms supratrochanteric shortening,confirmed by byrants triangle base.
specific
tests:
Narath sign: negative.
Nelton’s line coinciding on rt
side below level of umblicus.
Shoemaker’s line : trochanter is out side of the line.
X
RAYS FINDING:
HEMI PELVIS ,LEFT HIP
A/P AND FROG LEG VIEW.
SHENTONS LINE WELL
MAINTAINED.
LOSS OF GREATER
TROCHANTER COUNTOR,EROSION OF GREATER TROCHANTER.
MULTIPLE CALCIFIED
LEISON AROUND THE HIP JOINT IRREGULAR AND VARIATING IN SIZE.
EROSION OF
SUPERIOR,WEIGHT BEARING SURFACE OF HEAD OF FEMUR AND ROOF OF ACETABULUM.
D.D OF –RAY FINDING:
1.MYOSITIS
OSSIFICANS. 3.CHRONIC IFECTIVE
PATHOLOGY AROUND HIP.? Tuberculosis.
2.NEOPLASM OF GREATER
TROCHANTER.
Whats ur Dx?
