Peer Reviewed

Radiology Quiz

New-Onset Groin Pain in an Elderly Woman

Namita Bhardwaj, MD, MS, MPH1,2 • Grant S. Pierre, MD3

  • AFFILIATIONS:
    1Department of Family Medicine, The University of Texas Medical Branch, Galveston, Texas
    2Department of Orthopedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas
    3Department of Family Medicine, University of Massachusetts, Worcester, Massachusetts

    CITATION:
    Bhardwaj N, Pierre GS. New-onset groin pain in an elderly woman. Consultant. Published online July 6, 2022. doi:10.25270/con.2022.07.00002

    Received January 11, 2022. Accepted February 25, 2022.

    DISCLOSURES:
    The authors report no relevant financial relationships.

    DISCLAIMER:
    The authors report that informed patient consent was obtained for publication of the images used herein.

    CORRESPONDENCE:
    Namita Bhardwaj, MD, MS, MPH, The University of Texas Medical Branch, 301 University Blvd, Route 1123, Galveston, TX 77555-1123 (nabhardw@utmb.edu)


     

    A 72-year-old woman presented with new-onset right hip pain. Approximately 2 weeks prior, she had fallen on her right hip while walking her dogs. At the visit, she reported the pain has been steadily worsening and now has difficulty bearing weight on her right leg. She describes the pain as aching and constant, originating in the right anterior groin and radiating down the leg. Except for pain with activity, she has not had any associated symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) have provided only minimal relief of her symptoms, but the pain does improve with rest.

    History. The patient has hypertension diagnosed several years ago that is well controlled with diet. She takes her dogs for 15-minute walks daily. The remainder of her medical history is unremarkable, and she takes no other medications.

    Physical examination. The patient is 157.5 cm tall and weighs 69.5 kg. Her blood pressure is 112/70 mm Hg; her other vital signs are within normal limits. There is diffuse tenderness to palpation over the right groin area. The right hip has limited range of motion in all planes. Flexion abduction and external rotation and flexion adduction and internal rotation of the hip produces pain that she rates as a 9 on a 10-point scale. Motor nerves are intact at the extensor hallus longus, flexor hallus longus, gastrocnemius, and anterior tibialis distribution. Dorsalis pedis pulse is palpable at 2+. Sensation to light touch is intact.

    Diagnostic studies. Radiograph and magnetic resonance imaging (MRI) of the right hip were performed (Figures 1 and 2).

    Figure 1 femoral fracture
    Figure 1. Radiograph of the right hip.

    Figure 2
    Figure 2. T1-weighted magnetic resonance image of the right hip.

     

    Based on the patient’s history, physical examination, and imaging findings, which of the following is the most likely diagnosis?

    A. Hip osteoarthritis
    B. Femoral neck fracture
    C. Trochanteric pain syndrome
    D. Meralgia paresthetica


    Answer and discussion on next page.