University of Tor Vergata, Medicine Department, Roma, Italy.
Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, Alcorcon, Madrid, Spain.
Physiother Theory Pract. 2020 Jan;36(1):249-257. doi: 10.1080/09593985.2018.1481163. Epub 2018 Jun 1.
: Nonspecific low back pain (LBP) is frequently managed by physiotherapists. However, physiotherapists in a direct access setting may encounter patients with serious medical conditions, such as Bone Marrow Edema Syndrome (BMES) of the hip with symptoms mimicking LBP. To our knowledge, this is the first case to describe hip BMES presenting as LBP. Diagnosis was based on the patient's symptoms in conjunction with magnetic resonance imaging (MRI). In order to avoid misdiagnosing the patient, primary care clinicians should be aware that BMES can mimic nonspecific LBP. : To present a rare clinical presentation of BMES of the hip mimicking nonspecific LBP. To the best of the author's knowledge, this is the first case to describe hip BMES presenting as mechanical nonspecific LBP. : This case report describes the history, examination findings, and clinical reasoning used for a patient with LBP as a chief complaint. Furthermore, the clinical presentation (i.e. pain location and its changes related to load) and the symptoms behavior (i.e. immediate symptoms decrease after few hip treatment sessions and quick worsening of the hip pain related to loading activities) after two treatment sessions increased the suspicion of an underlying medical condition of the hip joint and lead to the decision for additional evaluation. A MRI showed a serious hip BMES. : This case report highlights the importance of including a comprehensive and continuous differential diagnostic process throughout the treatment period, looking for those risk factors (i.e. red flags) that warrant further investigation and referral to the appropriate physician. Physiotherapy diagnosis should include clinical reasoning, clinical presentation, and symptom behavior in addition to appropriate referral for medical assessment and diagnostic imaging when appropriate. Physiotherapists working within a direct access environment have the competence and responsibility to participate with other health professionals in the differential diagnose process especially for patients presenting with serious pathology mimicking musculoskeletal disorders.
非特异性下腰痛（LBP）常由物理治疗师进行管理。然而，直接就诊的物理治疗师可能会遇到患有严重疾病的患者，例如髋关节骨髓水肿综合征（BMES），其症状类似于 LBP。据我们所知，这是首例描述髋关节 BMES 表现为 LBP 的病例。诊断基于患者的症状结合磁共振成像（MRI）。为避免误诊患者，初级保健临床医生应意识到 BMES 可模拟非特异性 LBP。
介绍髋关节 BMES 模拟非特异性 LBP 的罕见临床表现。据作者所知，这是首例描述髋关节 BMES 表现为机械性非特异性 LBP 的病例。
本病例报告描述了一位以 LBP 为主诉的患者的病史、检查结果和临床推理。此外，两次治疗后，LBP 的临床表现（即疼痛位置及其与负荷的变化）和症状行为（即髋关节治疗后数小时症状立即减轻，与负荷活动相关的髋关节疼痛迅速加重）增加了对髋关节潜在疾病的怀疑，并导致决定进行额外评估。MRI 显示严重的髋关节 BMES。
本病例报告强调了在整个治疗期间包括全面和持续的鉴别诊断过程的重要性，寻找那些需要进一步调查和转介给适当医生的危险因素（即“红旗”）。物理治疗诊断除了适当转诊进行医学评估和诊断性影像学检查外，还应包括临床推理、临床表现和症状行为。在直接就诊环境中工作的物理治疗师有能力和责任与其他健康专业人员一起参与鉴别诊断过程，特别是对于表现出模仿肌肉骨骼疾病的严重病理学的患者。
