Hip pain in pregnancy: Musculoskeletal pain or deep vein thrombosis?
Shafiullah Wardak, Zarghuna Taraki, Indira Yonjan, Wai Yoong.
Miss MC, a 22-year old Asian lady, presented with a 12 hour history of pain in her left hip (?thigh). She was 22 weeks pregnant and this was her first pregnancy which had otherwise been uncomplicated. The pain originated in the upper left hip (?thigh) and radiated to the left iliac fossa and also down the inner thigh into the knee joint. It was exacerbated by movement, lying flat and on weight-bearing. There was no history of trauma, sciatica or rheumatoid arthritis. Her BMI was within the normal range. There was no other significant past medical history. She had discontinued the oral contraceptive pill 3 months before conception and she had given up smoking shortly after conception. Apart from paracetamol and folic acid she was not taking any other medication.
On examination she was apyrexial. The left hip was held flexed. There was no swelling, erythema or lymphadenopathy. The anterior and medial aspects of the left thigh were tender to touch. All active and passive movements of the left hip were painful. Adduction and abduction of the left hip joint were significantly reduced. There was no loss of sensation, power, tone and reflexes. Routine blood tests were normal except for a low haemoglobin count.
After one week of treatment with simple analgesics the pain had failed to subside and she now needed crutches to walk. Therefore orthopaedic opinion was sought and physiotherapy input was recommended, which failed to make any significant improvement. An ultrasound Doppler of the leg was carried out which surprisingly showed deep vein thrombosis in the left femoral vein and left common femoral vein. Heparin treatment was started and the pain subsided within days. At 38 weeks gestation she gave birth to a healthy female baby. The thrombophilia screen at three months after delivery was negative.
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