These
BUTTOCK, HIP, and THIGH (buttocks)
Spasm of a small buttock muscle through which the sciatic nerve runs.
Looks like sciatic pain, but occurs in individuals with gait abnormalities, weakness of postural muscles, and pregnancy.
What DDx?
Piriformis syndrome
BUTTOCK, HIP, and THIGH (hip/thigh)
Pain in hip, no recent trauma, hx of corticosteroid use.
What DDx?
avascular necrosis of femoral head
KNEE AND CALF PAIN (knee)
Patient presents with aching pain at the front of his knee-cap/shin bone after sitting for a long time.
-What DDx?
tight quads/hamstrings
KNEE AND CALF PAIN (knee)
What serious DDx are you concerned about with locking? (1)
-alarm symptom
Meniscal tear
What are the DDx for buttock pain? (5)
1. Coccydynia
2. Sciatica
3. Hamstring/ischial tuberosity syndrome
4. Piriformis syndrome
5. RSD/CRPS
BUTTOCK, HIP, and THIGH (buttocks)
A woman who has just given birth, is now experiencing pain at the base of spine.
What DDx? (1)
Coccydynia
-can follow falls, childbirth, repetitive strain or surgery
BUTTOCK, HIP, and THIGH (hip/thigh)
Pain in hip, no recent trauma, no steroid use.
What DDx? (2)
1. osteoarthritis
2. RA
KNEE AND CALF PAIN (knee)
Patient presents with pain/snapping sensation on the lateral aspect of the knee after going up or downstairs or walking up or downhill.
-What DDx?
Iliotibial (IT) band syndrome
KNEE AND CALF PAIN (knee)
What serious DDx are you concerned about with severe pain, effusion, and fever? (1)
-alarm symptom
Septic joint
KNEE AND CALF PAIN (knee)
What serious DDx are you concerned about with neurovascular symptoms? (1)
Injury to nerve or damage to blood supply
BUTTOCK, HIP, and THIGH (hip/thigh)
Track runner, who specializes in sprints, has pain in the posterior thigh after first practice of the season.
What DDx?
Hamstring/ischial tuberosity syndrome
-higher risk if improper warm-up, fatigue, previous injury, strength imbalance, and poor flexibility
BUTTOCK, HIP, and THIGH
What serious DDx are you concerned about with loss of bowel or bladder control or persistent sensory abnormalities (especially if associated with back complaints)? (2)
-benign (1)
1. Lumbar nerve root or spinal cord disorders (cauda equina)
2. Epidural metastasis
1. Anxiety
KNEE AND CALF PAIN (knee)
Patient presents with aching pain at the front of his knee-cap that feels better after rest and with icing, feels worse with flexion and extension.
-What DDx?
Patellar tendinitis
CALF PAIN
What serious DDx are you concerned about with calf redness, warmth, swelling? (2)
-alarm symptom
1. DVT
2. Cellulitis
65 yo pt presents with bilateral anterior knee pain that has worsened over the last month. Also has had intermittent knee pain for 5 yrs. No trauma, swelling, warmth, fever, or erythema. Pain worsens with climbing stairs and when standing from a seated position.
-What DDx
Patellofemoral syndrome
BUTTOCK, HIP, and THIGH (hip/thigh)
Shooting, sharp, burning pain in the anterior thigh; worse with sneezing coughing, or sitting.
What DDx? (2)
1. Lumbar radiculopathy
2. Quadriceps or adductor strain
BUTTOCK, HIP, and THIGH
What serious DDx are you concerned about with inability to bear weight? (2)
-benign (2)
1. Hip fracture
2. aseptic necrosis of femoral head
1. tendinitis, bursitis
2. degenerative joint disease
KNEE AND CALF PAIN (knee)
Patient presents with medial knee pain. She heard a pop and then there was immediate swelling?
-What DDx?
Ligamentous tear (MCL in this case)
-LCL if lateral knee pain
KNEE AND CALF PAIN (knee)
What serious DDx are you concerned about with giving way? (1)
Ligamentous injury
CALF PAIN
What serious DDx are you concerned about with fever, calf swelling, SOB, pleuritic chest pain? (2)
-alarm symptom
1. DVT
2. PE
BUTTOCK, HIP, and THIGH (hip/thigh)
Steady, severe pain at the hip joint; is worse in the morning or with prolonged use.
What DDx? (2)
1. Osteoarthritis
2. Rheumatoid arthritis
BUTTOCK, HIP, and THIGH
What serious DDx are you concerned about with painful redness and swelling of the thigh (particularly over common femoral vein? (1)
BONUS:
-benign (2)
1. Thigh DVT
-high risk for PE
1. Local trauma
2. skin infection
KNEE AND CALF PAIN (knee)
Patient presents with medial knee pain. She heard a pop and then became swollen over several hours?
-What DDx?
Meniscal tear (medial)
-lateral MT if lateral pain
CALF PAIN
Patient presents with calf pain, hx reveals swelling behind the knee prior to calf pain.
-What DDx?
Dissecting baker cyst
What serious DDx are you concerned about with fever, ulceration, or skin redness (warmth)? (2)
1. Cellulitis
2. Septic arthritis