Disclosures: Kyle Smith, MD: No financial relationships or conflicts of interest

Case Diagnosis: Osteoarthritis (OA) and avascular necrosis (AVN) of the left hip

Case Description or Program Description: A 56-year-old male presents with low back pain and left groin pain with radiation of pain and numbness/tingling into the left lower extremity along the medial thigh and medial leg to the dorsum of the foot, which began after pulling a heavy pallet. Prior x-ray of the left hip from years ago showed moderate-to-severe degenerative changes of the femoroacetabular joint with findings concerning for AVN.

Setting: Outpatient musculoskeletal clinic.

Assessment/Results: An MRI of the lumbar spine revealed posterior disc annular tears at L4-L5 and L5-S1 as well as mild left L4-5/L5-S1 neural foraminal stenosis. EMG of the left lower extremity showed no evidence of radiculopathy, plexopathy, mononeuropathy, or polyneuropathy. An updated x-ray of the left hip showed interval progression of femoroacetabular degenerative changes with AVN of the femoral head and subchondral collapse. An ultrasound-guided left intra-articular hip corticosteroid injection provided significant relief of left groin pain and significant relief of radiating pain, numbness, and tingling in the left lower extremity that lasted several weeks.

Discussion (relevance): The patient’s initial presentation was concerning for lumbosacral radiculopathy; however, EMG of the left lower extremity was normal and MRI of the lumbar spine showed only mild abnormalities. Patient’s significant improvement after receiving a left intra-articular hip corticosteroid injection confirms that intra-articular hip pathology is the primary etiology of his symptoms.

Conclusions: Although OA and AVN of the hip often present as pain in the groin, thigh, and/or buttock, it is important consider that OA and AVN of the hip can mimic lumbosacral radiculopathy and refer pain in a radicular fashion to the leg and foot. In such cases, an intra-articular hip corticosteroid injection should be considered for diagnostic and therapeutic benefit.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2022

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/osteoarthritis-and-avascular-necrosis-of-the-left-hip-presenting-as-lumbosacral-radiculopathy-a-case-report/