A 55-Year-Old Man Comes to the Physician with a 3-Month

question 167

Multiple Choice

A 55-year-old man comes to the physician with a 3-month history of right groin pain.  It initially occurred only during weight-bearing maneuvers but now has become constant.  He has no fever, dysuria, or paresthesia.
The patient underwent renal transplantation 10 years ago due to polycystic kidney disease.  His other medical problems include hypertension and spinal stenosis status post lumbar laminectomy.  His medications include prednisone, mycophenolate, and sirolimus.  He does not use tobacco or alcohol.
His temperature is 37 C (98 F) , blood pressure is 114/67 mm Hg, pulse is 72/min, and respirations are 14/min.  The abdomen is soft and nontender.  Range of motion and curvature of the spine are normal with no pain to palpation noted.  Internal rotation of the right hip joint is restricted due to pain.  There is no warmth, swelling, or erythema to the joint.  Neurologic examination is within normal limits.  Pinprick and light touch sensations are intact.
Laboratory results are as follows:

X-ray of the right hip shows mild joint space narrowing between the femur and acetabulum.
Which of the following is the most appropriate next step in management of this patient?

• A)Heat and passive stretching exercises
• B)Indium-111 WBC scan
• C)MRI scan of the hip joint
• D)Ultrasound-guided steroid injection of the hip joint
• E)X-ray of lumbosacral spine

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