PCL 7 Jane Gives Up Dancing

Jane
- 57
- teaches in a kindergarten
- slightly overweight
- dance
- walks 2 km to LRT station
- no history on

* Cheif Complaint = Dull nagging pain = chronic pain
* progressively getting worse
- pain in the hip and right knee
- aggravated by bending down = forward flextion
- past 6 months - symptoms getting worse
- pain intensified when stood up after sitting , especially after a few hours
- alleviating factor - after a good sleep
- takes paracetamol and Ponstan ,diclofenac
- Associated symptoms - cannot dance
- Beliefs - overweight, arthrits(familiy history)

Family Hx (should ask for 3 generations)
- mother had arthritis in her 60s, hands and knees
- Any chronic illnesses like hypertension , diabetes,stroke, liver disease, kidney disease , cancer

Past Hx & Surgical Hx
- Any chronic disease
- Admitted to hosp before?

Social Hx (lifestyle)
- live alone / single, Pets? anyone else at home?
- walks to the LRT
- Stress Management
- travel, financial , vaccination
- drugs, alcohol

Examination
1. Area appropriately exposed - consent
2. Inspection : Both sides to compare
- bony deformities (surface anatomy),muscle deformities,structural deformities, scars,trauma
3.Palpation - feel and check for temperature (hernia)
- inguinal lymph nodes ( flat fingers for tenderness 0
4. Movements - ask patient to walk across the room (straight line then turn)
- looking at posture
- coordination

Jane's
- painful internal rotation and external rotation of the affected hip
- abduction lesser on the affected hip
- groin most painful
- knee no evidence of swelling and a normal range of pain free movenment & stability
- pelvis dropped down on the other side when standing on painful leg

Learning Issues
1. What is Osteoarthritis ? how bad ? - Jon
2. Incidence and Prevalence - Chances to have it - Jinli
3. Risk Factors - Revathy
4. Signs and Symptoms - Amlah
5. Clinical Examination -- Demonstration - Dave and Sharvin
6. Differential Diagnosis - Valerie
7. Investigations - Rezza
8. Diagnosis - Deena and Gurki
9. Treatment and management ( pharmacological & non pharmacological & Complementary meds ) - Nicole and Charlene
10. Prognosis - Teh
11. Differences between osteoarthritis and rheumatoid arthritis - Lincoln