CPC - Hip Pain in Young Man

Case
CC: 39M c/o right hip pain
VS: WNL
...waiting 6 hours ot be seen
HPI: dull, constant aching x 3 months, worse iwth physical activity, acutely worse after basketball today, happening more often
No trauma (remote surgery of right knee), has unprotected intercourse with monogamous partner
Soc/Fam: remote drug history (not IV); active, fit, plays basketball frequently
ROS: sporatic back pain, infrequent night sweats over summer, occasional numbness/tingling in right foot
PE: right hip pain with add/ab, prominent thoracic spine
DDx: traumatic injury/repetititve injury, cauda equina, epidural hematoma, joint infection, ankylosing spondylitis, bony fracture, discitis
Labs: normal
XR hip: erosion at hte femoral head-neck junction, osteopenia, loss of joint space

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Gibbus formation

• collapse fo vertebral body 2/2 adv skeletal dx
• causing structural kyphosis

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Potts Disease

• spinal tuberculosis
• 21% of TB cases
• hematogenous spread
• cold abscess (little inflammation) w destruction of vertebae
• • constitutional sxs in only 20-30%
• neuro deficits are subtle
• • TTP, radiation, weakness/numbess
• Pott's paraplegia
  
  • can occur at any stag eof vertebral dz
    
  • minimal or no warning, w/o trauma​

Phemister's Triad: Case courtesy of Dr Matt Skalski, Radiopaedia.org. From the case rID: 25197

• Phemister's Triad
• • erosion at had-neck junction
  • osteopenia surrounding the joint
  • loss of joint space
• additional imaging is needed
• • lung XR
  • • colsolidation 50%
    • hilar and medistinal LAN 35%
    • cavitation 29%
    • normal 15%
• RF's
• • imigration from endemic areas
  • time in prison, mental health institutes, shelters, refugee camps
  • employment in health care
  • HIV

Other Extrapulmonary TB

• lymph nodes
• • chronic, nontender, cervival LAN
  • constintutional sx
• pleura
• • chronic cough, pleuritic CP, progressive dyspnea
• skeletal
• •  35% of EPTB cases
  • requires complete MRI of spine and NSGY

Tx Pearls

• tx varies with suspicious, severity, co-infx
• EPTB tx for 6 months
• • bone/joint and CNS tx for 9 months
• tx all pregnant women
• tx meds have interations with HIV meds
• Bottom line: call ID

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