Case Studies

A 79-year-old Caucasian retired physician presented to the clinic with a severe complaint of bilateral hip pain that had been persisting since last 2 years with unbearable episodes of pain over the previous three months. His pain was dull and achy, and started anteriorly in both the hips with occasional radiation to the groin. The pain ratings at its most severe point were 7 and 5 on a ten-point scale in the left and the right hip, respectively. The pain was most severe in the morning, when the patient woke up and in the evening after completion of all day to day activities. Acetaminophen 650mg bid as well as tid was no longer effective in relieving his pain. However, Ibuprofen 400 mg tid did show some improvement. The patient was unwilling to begin NSAIDs because of the fear of having gastrointestinal (GI) adverse events. Tramadol, hydrocodone, and oxycodone in the past lead to troublesome lightheadedness.

What will most likely explain the symptoms reported by the patient in this case?

  • Bilateral Hip Osteoarthritis
  • Spinal Stenosis
  • Greater Trochanteric Bursitis
  • Osteonecrosis

23min read    

A 17-year old male athlete participating in a fall league ice hockey game reported that he and an opponent, who had the puck, skated towards each other at high speed. The athlete tripped over a teammate's stick, fell forward, and the top of his helmet forcefully impacted the opponent’s leg at approximately mid-thigh.

At the time of impact, his neck was straight and his stick was held in front of him with both hands. His stick broke upon contact with the opponent, likely the lower leg, at approximately the same time the head impact occurred. He was unable to get up and reported feeling pins and needles in his hands and upper arms. The patient reported approximately 1 minute of functional quadriplegia. Neck pain after the impact was minimal. He had transient quadriplegia until external stabilization and distraction could be applied with a well-fitting halo-vest. His leg function returned prior to arm function.

What is the most likely diagnosis of this case presentation?

  • Vertebral dislocation
  • Teardrop fracture
  • Vertebral compression fracture

39min read    

A 43-year-old man presented to the orthopedic outpatient clinic with 2-months history of pain and limited range of motion in his left shoulder. His pain was insidious in onset, mild to moderate in intensity, aggravated by activities and associated with moderate rest and night pain. There was no history of direct or indirect trauma to the left shoulder. Patient was diagnosed as frozen shoulder at an outside facility and had been given intraarticular Depomedrol 40 mg injection for the same 40 days ago with no improvement in his symptoms. He had no fever, chills or rigors. He had no weight loss or loss of appetite. He was diabetic and had liver cirrhosis and was on treatment.

What is the most likely diagnosis of this case presentation?

  • Muscular pain

  • Shoulder Fracture

  • Septic Arthritis

23min read    

A 62-year-old female was admitted to our outpatient clinic with pain on the ulnar side of the right (dominant) forearm which began suddenly after lifting a light object seven days ago. There was no other history of trauma or fall. Plane radiographic examination revealed a fracture at the proximal one-third of the ulna. The fracture was a transverse fracture and there was marked bony sclerosis at the fracture line.

These symptoms are most consistent with which of the following disease?

  • Osteoarthritis
  • Osteoporosis
  • Rheumatoid arthritis
31min read    

A 62-year-old white female with no documented past medical history of hypertension or any other chronic disease state presented to the Emergency Department with severe occipital headache and was found to have hypertensive urgency, with initial blood pressure (BP) of 225/110 mmHg. She had started taking OTC ibuprofen 3200-4000 mg daily for three weeks due to cervical-spine radicular pain. She initially received 0.2 mg of clonidine and the ibuprofen was discontinued.

What could be the major cause for Hypertensive urgency here?

  • NSAIDs
  • Co-morbidities
  • Concomitant medicines
25min read