Mrs. R. is a 66-year-old female who presents to the clinic with pain in her left hip that worsens with walking, bending, standing, and squatting. When asked to describe where the pain occurs, she places her fingers around the anterolateral hip region. She denies any back pain, or pain in the posterior hip or along the lateral thigh. Denies any previous injury, stumbling, tripping or falling. She states that the pain has been getting gradually worse and is almost constant if she walks or stands for a long period of time. She denies back pain, numbness, tingling, or weakness in the extremities. She reports taking Ibuprofen 800 mg approximately 3 times/week whenever she has significant hip pain. She is concerned that she doesn’t know what is causing the pain and that she is having to take increased doses of ibuprofen to manage the pain. She reports a current pain level of 8/10 on the pain scale.

Background Information

She walks approximately 1 mile a day. She recently retired as an office manager 4 years ago.

PMH

Unremarkable

Immunizations

All vaccines are current

Screenings

Never had a colonoscopy

Last mammogram was 5 years ago

Social History

Has an occasional glass of wine with dinner

Does not smoke

Surgical history

Cholecystectomy 20 years ago

Hysterectomy 10 years ago

Current Medications

Ibuprofen 200-800 mg prn for hip pain

Discussion Questions Part One

• What risk factors does this patient have that might contribute to her hip pain?
• What ROS would you conduct on this patient?
• What is your primary diagnosis? What evidence-based resource and patient data supports this diagnosis?
• What two differential diagnoses are appropriate in this patient’s case? What evidence-based resource and patient data supports these two differential diagnoses?
• What screening would you choose to best evaluate this patient’s chief complaint?