81-Year-Old Woman With Left Hip Pain

Abstract

An 81-year-old woman presented to her primary care physician with left hip pain. Two weeks previously, she had fallen while walking to the bathroom, landing on her left side. She had no prodromal symptoms or loss of consciousness before or after the fall. She initially experienced mild tenderness around her hip area, but the tenderness became progressively worse with associated swelling causing difficulty in ambulation. She was seen by a neurologist about a 1 week after the fall for a recent diagnosis of Parkinson disease. During that visit, a large bruise was noted over the left greater trochanteric area with no associated focal neurologic deficit. Radiography of the left hip yielded no evidence of any acute fracture at that time. Her medical history was notable for chronic low back pain, osteoporosis, polymyalgia rheumatica, and the recently diagnosed Parkinson disease. Medications at presentation included risedronate, carbidopalevodopa, which was initiated about 1 month before presentation, and prednisone. Physical examination revealed a thin, pale,