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What is the pain source? A case report of a patient with low back pain and bilateral hip osteonecrosis
Amy L Minkalis1, Robert D Vining2
1Research Clinician, Evidence-Based Clinical Practice Scholar, Graduate Research Fellow, Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA.
Background:
Low back pain is a common symptom arising from many possible sources and includes the possibility of the contribution of remote pathology. This report describes a patient with bilateral osteonecrosis of the femoral heads presenting with a primary symptom of low back pain.
Case Presentation:
A 37-year-old male presented for evaluation of dominant pain that existed for approximately 6-12 months and was located in the right low back. Milder pain was also reported in the right hip. Low back and hip pain were both aggravated by weight-bearing activities. An evidence-based diagnostic evaluation revealed little indication for a primary pain source originating from low back structures. Radiographs revealed bilateral osteonecrosis with evidence of left femoral head collapse.
Conclusion:
Hip osteonecrosis may have contributed to an atypical presentation of low back pain due to aberrant localization of pain and/or combined with altered biomechanical loading of musculoskeletal structures.
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