yellow flags

I am currently on my musculo placement and am seeing quite a difficult patient in regard to diagnosis and treatment. She was referred to the clinic by her GP with severe (L) hip pain. On initial assessment however, she explained that this pain only occurred when she had her period and other than that it was usually fine. She also said that she has had 40 anaesthetics, several of which were for gyno and pelvic surgeries, of which her most recent was only 3 months ago.

On objective assessment she showed near full range of movement but it was just very painful. We went through all the usual tests for the hip and screened the joints above and below, but still found nothing too out of the ordinary that would be causing such pain. When we suggested that her pain was possibly of visceral origin as her symptoms are so closely linked with her menstrual cycle, she said we must have missed something as her doctor would not have referred her to a physio if we could not help.

My supervisor suggested a ‘working diagnosis’ of posterior capsule tightness however feels this is unlikely. I tried a caudad/lateral glide with a bit of distraction to try and open up her hip joint however this nearly brought on tears. We saw the patient every week for a month and her pain is definitely consistent with her menstrual cycle. I suppose this is the first real patient that I have had with such obvious yellow flags and whilst she does have some evidence of very minor musculoskeletal problems it is very unlikely that this is causing her extreme pain. Treating this patient has given me experience in regard to when it’s indicated to refer a patient back to their doctor for further investigations. Just because the doctor referred them for physio does not mean its necessarily indicated and it has made me more confident in knowing when to refer a patient on to someone with more experience/knowledge.