40F WITH RIGHT THIGH PAIN AND BACK PAIN SINCE 5 YRS

 28/10/2026

THIS PATIENT DATA WAS GATHERED BY ROLL NO9, BATCH 2023 AS PART OF HER COMPETENCE BASED LEARNING EVALUATION PORTFOLIO PREPARATION

40F HOMEMAKER WITH RIGHT THIGH PAIN AND BACK PAIN SINCE 5 YRS

40 years / Female / Homemaker

C/O:

Right thigh pain - 5 years, Back pain - 5 years

HOPI:

Patient was asymptomatic 5 years ago then developed back pain and right leg pain since due to surgery.

N/K/C/O - DM, TB, Epilepsy, N/K/C/O - Hypertension.

Past History:

Patient met with an accident 5 years ago.

- Femur fracture -> surgery was done

- Rod has removed 1 year ago.

- Patient had hypertension but now it is normal without medication.

Personal History:

Diet - Mixed, Sleep - Adequate, B&B - Normal, Appetite - Normal, Addictions - Nil

Family History: No similar family history

General Examination:

Pulse - 80 bpm, Temp - 98.7 F, Blood pressure - 120/80 mmHg, PICCLE - Absent

Provisional: Post femur fracture - Implant removal - with back pain and thigh pain

Here is a colorful medical infographic summarizing the clinical case report, along with a set of Socratic questions to guide clinical reasoning and critical thinking about the patient's presentation.

Clinical Case Infographic Summary

 * Patient Profile: 40-year-old female homemaker.

 * Chief Complaints: Right thigh pain and back pain persisting for 5 years.

 * History of Present Illness (HPI): Symptoms began following an accident 5 years ago, which resulted in a femur fracture treated surgically.

 * Past Medical & Surgical History:

   * Met with an accident 5 years ago \rightarrow femur fracture requiring surgery.

   * Implant rod removed 1 year ago.

   * History of hypertension, currently normal without medication.

   * No known history of Diabetes Mellitus, Tuberculosis, or Epilepsy.

 * Vital Signs & Examination:

   * Pulse: 80 bpm | Temperature: 98.7°F | Blood Pressure: 120/80 mmHg.

   * PICCLE (Pallor, Icterus, Cyanosis, Clubbing, Lymphadenopathy, Edema): Absent.

 * Provisional Diagnosis: Post-femur fracture status post implant removal, presenting with chronic right thigh and back pain.

Socratic Questions for Clinical Reasoning

 * Pathophysiology & Mechanics:

   * How might the altered biomechanics or gait changes resulting from a femur fracture 5 years ago contribute to chronic secondary back pain?

   * In what ways could the surgical intervention or subsequent implant removal have impacted the surrounding muscle groups (such as the quadriceps or hip flexors) to cause persistent localized thigh pain?

 * Differential Diagnosis:

   * Beyond post-traumatic musculoskeletal strain, what other potential causes of chronic back and thigh pain—such as lumbar radiculopathy, facet joint arthropathy, or bursitis—should be ruled out?

   * Could the implant removal itself have left any structural weakness, localized scar tissue, or periosteal irritation that continues to trigger pain signals?

 * History & Timeline Correlation:

   * Since the pain onset began 5 years ago concurrently with the accident, but the implant rod was only removed 1 year ago, how did the character or intensity of the pain change (if at all) following the rod removal?

 * Diagnostic & Management Strategy:

   * What imaging studies (such as an X-ray of the femur and lumbar spine, or an MRI) would be most beneficial at this stage to evaluate the integrity of the healed bone and the lumbar spine?

   * How might physical therapy focusing on core stabilization and hip/thigh strengthening alter this patient’s long-term functional recovery compared to pharmacological management?