Physical Therapy Screening of Occult Cancer Presenting as Hip Pain in Acute Care Setting

Copyright © 2020 Academy of Acute Care Physical Therapy, APTA ABSTRACT Background and Purpose: Physical therapists (PTs) in the acute care setting evaluate patients to determine discharge plans and perform mobility-based safety evaluations. When presented with a common problem different from the referral diagnosis, in this case, hip pain, the PT must use knowledge of palpation, range of motion, special tests, and outcome tools to evaluate the patient and identify possible sources of their pain. This case report aims to describe a patient’s atypical presentation of hip pain that was ultimately diagnosed as metastatic bone disease. This report includes the description of differential diagnoses based on the patient examination, details of the subsequent events leading to her final diagnosis, and discussion of the importance of screening patients beyond their diagnosis in the acute care setting. Case Description: A 69-year-old woman was referred to physical therapy in the hospital following aortic surgery. During the initial evaluation, she described 10/10 hip pain that had gone undocumented thus far. Examination revealed pain with passive and active motion in all directions, increased pain with weight-bearing, and impaired mobility. Current evidence for the evaluation of hip pain was used to examine differential diagnoses aligned with the patient’s symptoms. Based on the PT’s evaluation, subsequent referrals and imaging were warranted and led to a diagnosis of metastatic adenocarcinoma. Conclusion: Hip pain caused by sinister pathologies is unusual. In this case, a PT identified “red flag” symptoms during the initial evaluation and collaborated with other providers for further investigation. The skilled evaluation and timely referral led to the discovery of previously undiagnosed metastatic adenocarcinoma.