AVN

💡Case study brought by #traineeGP , second opinion by me

👀 52 M presented with groin pain left >right

Active and fit plays hockey, football, gym 3/week - free weights and machines

👀 PMH- NAD

👀 Pain and tenderness on pubic symphysis

🧐 Hip FROM , Resisted hip movements 5/5 not painful , lumbar spine clear , gait ,balance function - no deviations , slight pains with hip internal rotation and SCOUR ? Left > right

❓Differentials - #adductorstrain , #Hipflexor , #OA , #osteitispubis ( TraineeGp) and #avn

🩻 suggested GP to get X-ray

#OA of left #hip with sclerotic AVN femoral head

#avascularnecrosis femoral head - AVNFH

is rare 2 per 100000 in UK😵

💁‍♂️M 25-44 age

💁‍♀️F 55-75 age

⚠️Risk factors -

#alcoholism 🍺 , #smoking 🚬, #obesity ,

#familyhistory #immunocomprimised #chemotherapy #hiv #steroids

🧐Examination - hip rotation in supine or sitting

Referred to #orthopaedics for urgent MRI ‼️

⚠️early detection is necessary if needs surgery or treatment

👀One of the common causes for #hipreplacement

https://www.bmj.com/content/365/bmj.l2178

#primarycare #fcp #firstcontactphysiotherapy #firstcontactphysio #mdtworking #multiprofessional #primarycarenetwork