Hip Joint: History Taking (Long Case)

My patient Mr. X, son of Mr. Y, 40 years old male, labourer by occupation, Resident of Z, presented with the CHIEF COMPLAINTS of

1. Pain in right hip for 3 years
   
2. Difficulty in walking /weight bearing for 3 years
   
3. Limp for 3 years
   
4. Deformity of right hip/shortening of right lower limb for 2 years
   
5. Restriction of movements (stiffness) of right hip for 6 months

HOPI (History of Presenting illness)- as stated by the patient

Patient was apparently asymptomatic 3 years back when he developed PAIN over his right hip, which was insidious in onset, gradually progressive, continuous/intermittent, mild to moderate in intensity, stabbing/pricking/dull aching in nature, non-radiating, aggravated by wt bearing/movement/walking, relived by taking rest/walking and medications. There was no diurnal or seasonal variation.

Pain was associated with DIFFICULTY IN WEIGHT BEARING. Initially patient was able to bear weight with discomfort but later he had to take support of wall/stick/family-member.

About the same time pt developed LIMP, which used to start with first step, was painful and non- progressive. He uses STICK in the opposite hand (in painful hip).

Patient also complaints of DEFORMITY/SHORTENING of the right lower limb/hip for 2 year which was insidious in onset/since birth/appeared after an episode of high grade fever or myalgia or weakness of lower limb; and is gradually progressive.

Patient also complaints of RESTRICTION OF MOVEMENTS/STIFFNESS of right hip for 6 months which was insidious in onset, gradually progressive, appeared after a period of rest/more in the morning, persisting for > 1 Hr and relived by exercise.

For these complaints patient took TREATMENT from a local medical practitioner and got treatment in the form of oral medications/traction/plaster, but got only partial relief of his symptoms so he consulted this hospital 4 days back. Here treatment was given in the form of bed rest/ traction/ oral and injectable medications.

Patient reports relief in his symptoms after coming to this hospital.

At present patient is walking with the help of walker in the home only. He is not able to squat/sit crossed leg.

• There is no history of trauma.
• There is no history of fever, chronic cough, weight loss, appetite loss, night sweats and night cries, contact with tuberculous pt.
• No history of long term drug intake.
• No history of other joint involvement, morning stiffness (> 1 hr).
• No history of redness of eyes, burning micturition or skin rashes.

PAST HISTORY

• There is no history of tuberculosis, asthma, DM, HTN.
• No history of any hospital admissions or surgery in the past. 
• No h/o similar complaints in the past.

MENSTRUAL HISTORY

• LMP was XXXX, cycles are regular.

DEVELOPMENTAL HISTORY

• Pt is 1st born child, it was a supervised pregnancy with regular antenatal checkups, delivery was normal vaginal done at home/ by LSCS in hospital, pt was a full term/preterm baby, cried immediately after birth, did not required any NICU admission.
• Pt is fully immunised till date and developmental milestones were attained at appropriate age.

FAMILY HISTORY

• No h/o Dm, HTN, asthma, tuberculosis/ similar complaints in the family.

PERSONAL HISTORY

• Pt is vegetarian/non-vegetarian by diet, appetite is reduced, sleep is reduced, history suggestive of bowel bladder dysfunction present, there is no addiction, pt belongs to lower socioeconomic status.