Hi everyone
My post is about difficult musculoskeletal presentations. I had a patient present to me with a 14yr history of longstanding hip pain (since she was 11) that begun insidiously. Her presentation is that after playing sport (netball/hockey) she will feel her (R) knee turning in, and then for the next few days she will have intermittant stabbing sharp hip pain deep within her joint with certain mvmnts eg. crossing her legs. After a few days it will disappear again, and it is only in the few days post sport that this pain appears. Objectively she had decreased ER ROM actively and passively on the (R) side, and no other findings. The pain could not be reproduced as it is the 'off-season' and she only gets the pain after playing sport.

So I was pretty confused with this lady... the best diagnoses I could vaguely come up with was perhaps an old labral tear from whe she used to play gymnastics when she was young, which gets aggravated with sport (+/- synovitis?) and catches in the hip joint. Perhaps also related to poor glut med pelvic control making her knee turn in after sport? But I really wasnt too sure and neither was my supervisor. Treatment over 2 Rx sessions consisted of some ER mobs at 90 degrees flexion, ER self-stretches for home and a program to strengthen glut med (although (R)glut med was G4+ on testing, probably stronger than me).

The outcome was that we decided to wait until she was playing sport again and could monitor response to treatment more accurately and told her to come see us again then, bypassing the 5 month waiting list. We sent a letter to the doctor about our findings and suggesting that imaging could be the only was to conclusively diagnose her hip pain. We also suggested to her that if it was a problem within the hip joint capsule as it seemed, physio perhaps wouldnt really help too much.

What I learnt from this is that there are still so many musculoskeletal dysfunctions out there that I still have no idea about, and this will still probably happen for some time. Referring back to the doctor saying 'I dont really know whats going on' and requesting imaging is sometimes all that can be done.
Any ideas about what the pathologycould be would be greatly welcome!
Hope the tail end of everyone's last prac goes well.