The patient is a 26-year-old woman who presented with 5 months of right hip pain and inability to walk for 1 month. She has a history of systemic lupus erythematosus treated with chemotherapy. On examination, she had tenderness over the right anterior hip with limited range of motion. X-rays showed stage 3-4 avascular necrosis of the right femoral head. The patient was diagnosed with avascular necrosis of the right hip secondary to her history of lupus and steroid use.
The patient is a 26-year-old woman who presented with 5 months of right hip pain and inability to walk for 1 month. She has a history of systemic lupus erythematosus treated with chemotherapy. On examination, she had tenderness over the right anterior hip with limited range of motion. X-rays showed stage 3-4 avascular necrosis of the right femoral head. The patient was diagnosed with avascular necrosis of the right hip secondary to her history of lupus and steroid use.
The patient is a 26-year-old woman who presented with 5 months of right hip pain and inability to walk for 1 month. She has a history of systemic lupus erythematosus treated with chemotherapy. On examination, she had tenderness over the right anterior hip with limited range of motion. X-rays showed stage 3-4 avascular necrosis of the right femoral head. The patient was diagnosed with avascular necrosis of the right hip secondary to her history of lupus and steroid use.
The patient is a 26-year-old woman who presented with 5 months of right hip pain and inability to walk for 1 month. She has a history of systemic lupus erythematosus treated with chemotherapy. On examination, she had tenderness over the right anterior hip with limited range of motion. X-rays showed stage 3-4 avascular necrosis of the right femoral head. The patient was diagnosed with avascular necrosis of the right hip secondary to her history of lupus and steroid use.
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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.