A 56-Year-Old Teacher With Worsening Hip Pain

A 56-Year-Old Teacher With Worsening Hip Pain

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Avan Armaghani, MD

April 06, 2020

Editor’s Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

A 56-year-old woman with no significant past medical history presents with left hip pain. She began experiencing this pain about 4 months ago. She says that she initially noticed the pain when she was walking and that it would resolve with rest.

She saw a chiropractor and physical therapist but experienced only minimal relief. The pain then became progressively worse, and she began experiencing it at rest. She rates the pain as “8 out of 10” on a pain scale. She describes it as achy and localized in the left hip. The pain does not radiate down her leg. She denies any stiffness feeling in her hips.

The patient has taken over-the-counter pain relievers, which temporarily reduce the pain to “5 out of 10” on a pain scale. She has never experienced a similar sensation. She does not report any weakness, numbness, or tingling sensation in her legs. She has not had any recent trauma. She does not have fever, chills, blurry vision, double vision, cough, chest pain, shortness of breath, nausea, vomiting, or abdominal pain.

The patient is otherwise healthy and does not take any other medications beyond the aforementioned pain relievers. She works as a third-grade teacher. She denies smoking and or drinking alcohol. She is postmenopausal. She has a family history significant for a maternal aunt who was diagnosed with breast cancer at age 45 years and underwent surgery, chemotherapy, and radiation treatment. The patient does not have any other family history of breast cancer, ovarian cancer, or other cancer.

Upon physical examination, the patient’s vital signs include blood pressure of 140/90 mm Hg, pulse of 85 beats/min, temperature of 98.3°F (36.8°C), respiration rate of 15 breaths/min, and weight of 189 lb (85.7 kg).

Her mental status appears normal. She is alert and oriented and is sitting comfortably, with no acute distress. Her pupils are symmetric and reactive to light. Her extraocular movements are intact. Her conjunctivae are normal. Her cardiac, pulmonary, abdominal, and musculoskeletal examination findings are otherwise unremarkable.

She has normal muscle bulk and tone and normal upper- and lower-extremity strength. She has no swelling or no deformities. She has no pain with compression of the left or right hip. Her sensation is intact bilaterally. She has 5/5 strength in hip flexion and extension, knee flexion and extension, and ankle dorsiflexion and plantar flexion bilaterally. Results of a straight leg test are negative bilaterally. Her gait is normal.

The results of her complete blood cell count with differential and comprehensive metabolic panel are within normal limits.

Medscape © 2020 WebMD, LLC

Any views expressed above are the author’s own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Avan Armaghani. A 56-Year-Old Teacher With Worsening Hip Pain – Medscape – Apr 06, 2020.

Assistant Member Breast Medical Oncology, Moffit Cancer Center, Tampa, Florida

Disclosure: Avan Armaghani, MD, has disclosed no relevant financial relationships.

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A 56-Year-Old Teacher With Worsening Hip Pain

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Cancer Treatment, Staging, & Guideline Syntheses

Cancer Treatment, Staging, & Guideline Syntheses

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Cancer Treatment, Staging, & Guideline Syntheses

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Understanding Cancer — the Basics

Understanding Cancer — the Basics

Understanding Cancer — the Basics

Throughout our lives, healthy cells in our bodies divide and replace themselves in a controlled fashion. Cancer starts when a cell is somehow altered so that it multiplies out of control. A tumor is a mass composed of a cluster of such abnormal cells.

Most cancers form tumors, but not all tumors are cancerous.

Benign, or noncancerous, tumors do not spread to other parts of the body, and do not create new tumors. Malignant, or cancerous, tumors crowd out healthy cells, interfere with body functions, and draw nutrients from body tissues.

Cancers continue to grow and spread by direct extension or through a process called metastasis, whereby the malignant cells travel through the lymphatic or blood vessels — eventually forming new tumors in other parts of the body.

Cancer

The term “cancer” encompasses more than 100 diseases affecting nearly every part of the body, and all are potentially life-threatening.

The major types of cancer are carcinoma, sarcoma, melanoma, lymphoma, and leukemia. Carcinomas — the most commonly diagnosed cancers — originate in the skin, lungs, breasts, pancreas, and other organs and glands. Lymphomas are cancers of lymphocytes. Leukemia is cancer of the blood. It does not usually form solid tumors. Sarcomas arise in bone, muscle, fat, bloodvessels, cartilage, or other soft or connective tissues of the body. They are relatively uncommon. Melanomas are cancers that arise in the cells that make the pigment in skin.

Cancer has been recognized for thousands of years as a human ailment, yet only in the past century has medical science understood what cancer really is and how it progresses. Cancer specialists, called oncologists, have made remarkable advances in cancer diagnosis, prevention, and treatment. Today, more people diagnosed with cancer are living longer. However, some forms of the disease remain frustratingly difficult to treat. Modern treatment can significantly improve quality of life and may extend survival.

SOURCES: 

National Cancer Institute. 

WebMD Medical Reference from the American College of Physicians: “Oncology I Cancer Epidemiology and Prevention.”

What you need to know.

How they work for blood cancers.

Separate fact from fiction.

And how to best treat them.

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Understanding Cancer — the Basics

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Cancer Treatment, Staging, & Guideline Syntheses

Cancer Treatment, Staging, & Guideline Syntheses

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Cancer Treatment, Staging, & Guideline Syntheses

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