title: Decision making for a painful hip: a case requiring referral.
abstract: METHODS
  Resident's case problem.
  
  
  BACKGROUND
  The purpose of this resident's case problem is to describe a 39-year-old female patient with insidious onset of hip pain. This patient had discrete findings on subjective physical examination that prompted referral for further imaging studies of the left hip and pelvis. Despite having seen multiple providers, no imaging of the involved hip or pelvis had been performed. A prolonged duration of symptoms, severe gait disturbance with an associted Trendelenburg sign, difficulty sleeping, and an empty end feel with passive range of motion increased concern that a pathological process might be present.
  
  
  METHODS
  Imaging studies revealed a large destructive soft-tissue tumor later found to be non-Hodgkin's lymphoma.
  
  
  CONCLUSIONS
  It is incumbent upon physical therapists to be aware of the potential for severe pathological conditions that mimic musculoskeletal complaints to exist and understand how to identify patients for whom further testing and/or referral may be appropriate. Existing guidelines for low back pain may assist with decision making in the absence of specific guidelines for when to request imaging in patients with nontraumatic hip and pelvis pain. Proficiency in screening for conditions not amenable to physical therapy treatment or that require consultation to other health care professionals is essential to physical therapy practice.
authors.affiliation: 959th Medical Operations Squadron, Wilford Hall Medical Center, Lackkland AFB, TX, USA. david.browder@lackland.af.mil
authors.forename: David A
authors.initials: DA
authors.lastname: Browder
authors.forename: Richard E
authors.initials: RE
authors.lastname: Erhard
mesh_terms: D000328:Adult; D003657:Decision Making; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D005260:Female; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis; D010146:Pain / Q000209:etiology*; D026761:Physical Therapy Specialty; D011859:Radiography; D012017:Referral and Consultation; D014481:United States