A 62-year-old patient presents with complaints of aching pain in the right groin that varies in severity and extends down the anterior thigh to the knee. The pain began gradually about 3 months before. Initially the patient felt stiffness whenever he sat for prolonged periods of time or after a night’s sleep. The patient reports that he can no longer walk as far as he once did, and that negotiating stairs was especially painful. The patient’s past medical history is significant for a long history of osteoarthritis of the spine and occasional twinges of pain in the right groin. The patient also has history of right-sided sciatica. Radiographs of the right hip were negative for loose bodies, tumors, and fracture, although advanced osteoarthritis of the right hip was noted.
List the areas of the body that can refer pain to the groin.
Lumbar spine, thoracic spine, symphysis pubis, hip joint and abdominal viscera can all refer pain to the groin.
What might the history of pain with early morning stiffness and pain with stair negotiation tell the clinician?
Complaints of hip or groin pain, morning stiffness, stiffness after sitting, difficulty with stair negotiation, and hip pain with weight bearing are suggestive of joint involvement, such as OA.
What other activities might increase the patient’s symptoms? Why?
Squatting, putting on socks or stockings.
Does this presentation/history warrant a Cyriax lower quarter scanning examination? Why or why not?
Even though advanced osteoarthritis was noted on the radiographs and the patient has a history of osteoarthritis, it would be prudent to perform a lower quarter scanning examination to rule out other potential causes for the symptoms.
Due to the insidious nature of the patient’s pain, a lower quarter scanning examination was performed but failed to elicit any signs and symptoms of serious pathology or overt neurologic compromise. The physical examination of the patient included an inspection for muscle atrophy, palpation for areas of tenderness and crepitus, muscle testing of all major muscles about the hip, measurement of active and passive range of motion, and special tests.
- Excessive hyperextension of the left knee is noted during stance, especially during the push-off phase as the patient ambulates by circumducting the right hip. A shorter stride length and decreased heel strike is noted on the right. The patient also demonstrated a lack of right hip extension, and right ankle plantar flexion at the end of single leg stance.
- Negative compression and distraction tests of the sacroiliac joint. Negative pubic stress tests. Positive scour test and FABER test of the right hip. Abnormal capsular end-feel noted at the right hip. A 5-degree flexion contracture is noted in ...