A Wine Drinker With Groin Pain After Gardening

Anthony H. Woodward, MD

Disclosures

July 20, 2023

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

A 64-year-old woman presents to her family physician's office with worsening groin and hip pain. She reports that she woke up one morning with pain in the proximal hamstring muscles of both thighs. A few days earlier, she had been gardening, but she recalls no other possible cause of these new symptoms. Over the next several days, the pain spread over both greater trochanters and into both groins. The pain worsened, waking her at night.

The pain is worse in the mornings but persists to some extent all day. She is unable to sit for long periods and has to get up and move around. Similarly, she can drive only 30 miles before having to stop, get out of the car, and walk around. The pain makes it difficult for her to walk uphill or go upstairs.

Previously, the patient's health was excellent. She takes no prescribed medications. She reports that she had a hysterectomy for dysfunctional uterine bleeding without complications. She has never smoked cigarettes or used illicit drugs, and she drinks one glass of wine on most days. Her family history is unremarkable.

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