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Case Base Discussion: PG2 DR Htet Arkar

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Case Base Discussion

PG2 Dr Htet Arkar


• Ma Kyi Myint, 26yrs old Lady, Single, housewife,
Burma, Buddish, from Magway Township,
DOA – 26.5.2020.
• C/O - Pain in Rt hip region x 5 mths
• - Inability to walk x 1 mth
• HOPI. She was previously well, suffered pain in Rt
anterior hip region last 5 months.
• At first, pain was insidious onset, dull aching in
nature, intermittent, mild and gradually increased
in intensity.
• She could not do her daily activities.
• Night pain present , no radiation and shifting pain.
• Pain was aggravated by Rt hip movement and relived
by lying on bed.
• Now, patient cannot stand and walk, so confined to
bed.
• She took analgesic for short duration by physician
order to relive pain.
• No history of fever, LOW, LOA and malaise.
• No history of trauma.
• No tingling and numbness sensation on both lower
limb
• She can move her Rt knee and ankle joint well.
• No muscle atrophy in Rt thigh and leg.
• PMH- History of SLE for 3 years and taking treatment
with physician. Last 6 mths, ? SLE nephropathy (+) and
aggressive chemotherapy was taken once per month.
• - No previous history of DM, Hypertension and
heart disease.
• - History of hospitalization (+) once per month for
chemotherapy in medical ward.
• PSH- No previous history of operation.
• P&SH – No history of alcohol drinking, smoking and
betel chewing.
• DH- NKDA, history of steroid taking (+) for 3yrs.
• Gynaecological h/o- LMP – not known, 2/30 day cycle,
slight reduced in amount.
• Family H/o- No history of TB contact in close
relatives.
• - No history of inflammatory arthritis,
metabolic disease, malignancy, bleeding
disorder in her family members.
• On system review
• CNS - No h/o of headache, dizziness, blurred
vision, syncope.
• CVS - No h/o of chest pain, palpitation,
dyspnoea.
• Resp - No history of cough ,haemoptysis ,
breathlessness.
• GI - No h/o of nausea, vomiting and epigastric
pain . Normal UO and BO.
• On general examination
GC-fair T- Nl ,no pallor, no jaundice
BP-120/80 mmHg,PR-72/min
SPO2-99% on air
Lungs-VBS+0
Heart- I+II+0
Abd – is moved with respiration, no visible swelling On
palpation, abd is soft, no palpable swelling.
Liver & Spleen are not palpable.
Kidneys are not blottable.
BS +
No inguinal lymph nodes enlargement.
On local examination

• Gait can’t be assessed as patient can’t


stand and walk due to pain.
• Trendelenburg test can’t be assessed due
to pain.
• Look
• Patient is average body build and height.
• Moon Face (+)
• FFD hip (+)
• No scars and sinuses
• No swelling around the hip
• No quadriceps muscle wasting
• Feel
• Normal skin temperature when
compared to the Lt side.
• Localized tenderness present on Rt
anterior hip region.
• Femoral pulsation, dorsalis pedis and
posterior tibial pulsation are intact on
both lower limbs.
• No sensory impairment on both lower
limbs.
• Thomas’ test - positive.
• FFD of Rt hip (+) about 40 degree.
• Sectoral sign – positive.
• Move
• Limitation of all m/m of Rt hip jt present
• No limitation on Rt knee and ankle
• Measure
• Apparent length is 3 cm shorten on the Rt side
• Real length is 1cm shorten on the Rt side
• Galeazzi’s test – positive ( shortening above the knee
(+) ).
• Bryant’s triangle- upward displacement on the Rt side
• Chiene’s line is converge on the Rt side
• Shoemaker’s line- converge below the umblicus on the Lt
side
Pelvic X ray (AP)
• Rt AVN of hip
• Ficat and Arlet – stage 3
• ARCO Staging – stage 4
THANK YOU.

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