Last month, I posted a case from my own practice to highlight issues of pain management in primary care. To recap: The patient was a 66-year-old woman with lifestyle-limiting hip pain and several medical comorbidities, including obesity and type 2 diabetes. I asked for, and received, numerous comments about my management of this patient.
Thank you for the great insights I've received. They are helpful and thought-provoking. I would like to address some emerging themes from your comments.
The case as originally presented had significant gaps, in large part because no one wants to read a five-page case online. But many of you are absolutely right in that we should not assume that older adults who present with hip pain automatically have osteoarthritis. The pain of osteoarthritis is usually anterior, but labral tears also produce this type of pain. However, if her pain is posterior, lumbar radiculopathy and sacroiliac dysfunction are more likely. Lateral hip pain, as suggested by readers, is often associated with inflammation of the greater trochanter. This patient needs a better history and good physical examination before cinching a diagnosis and recommending treatment.
The Surgery Question
Next up, the law of the instrument: If all you have is a hammer, then it is tempting to treat everything like a nail.
