Case 1

Patient Information:
Name: Patient 1

Age: 31

Gender: Male

Occupation: Retail manager

Hobbies: Yoga, gardening

Chief Complaint: Right-sided hip pain and generalized fatigue

Clinical History:
Crystal Steele presents with right-sided hip pain that started insidiously about 8 months
ago. The pain has progressively worsened and now radiates to her right knee and lower
back. She also reports generalized fatigue, joint stiffness, and swelling in her hands and feet,
particularly in the mornings. Crystal has been experiencing these systemic symptoms for
about a year, but they have become more pronounced over the last few months. She has lost
5 kg unintentionally over the past 6 months and feels increasingly fatigued, with occasional
episodes of low-grade fever.

Medical History:
Hypertension: Diagnosed 5 years ago, well-controlled with medication.

Diabetes Mellitus Type 2: Diagnosed 3 years ago, managed with diet and oral
hypoglycemics.

Family History: Mother had rheumatoid arthritis.

Medications:
Metformin

Lisinopril

Occasional use of NSAIDs for pain

Social History:
Non-smoker

Rare alcohol consumption

Active lifestyle, enjoys yoga and gardening

Physical Examination Findings:
Mild pallor, no jaundice.

Vital Signs:
Blood pressure: 135/85 mmHg

Heart rate: 78 bpm

Respiratory rate: 16 breaths per minute

Temperature: 37.5°C

Musculoskeletal:
Hip:

AROM: Decreased flexion and abduction on the right, limited by pain.

PROM: Pain and restriction in flexion and internal rotation.

AR-ROM: Grade 3/5 in right hip flexion with pain.

Knee:

AROM: Decreased flexion and extension on the right.

PROM: Pain and restriction in extension.

AR-ROM: Grade 4/5 in right knee flexion with mild pain.

Orthopaedic Tests:

Positive Faber's test on the right.

Positive Trendelenburg sign.

Neurological:
Decreased sensation in the right L2-L3 dermatome.

Mild weakness in the right quadriceps.

Reflexes: Normal patellar and Achilles reflexes.

Systemic Examination:
Cardiovascular: Normal heart sounds, no murmurs.

Respiratory: Clear breath sounds, no wheezes or crackles.

Abdominal: Soft, non-tender, no organomegaly.

Skin: Warm, dry, no rashes or lesions.

Diagnostic Imaging Report:
Findings:

X-ray of the hip shows joint space narrowing and osteophyte formation consistent with
osteoarthritis.

MRI of the lumbar spine reveals degenerative disc disease at L4-L5 with mild disc bulging.

Conclusion:

Right hip osteoarthritis

Lumbar degenerative disc disease

Lab Results:
Complete Blood Count (CBC): Mild anemia (Hb: 10.5 g/dL)

Erythrocyte Sedimentation Rate (ESR): Elevated at 35 mm/hr

C-Reactive Protein (CRP): Elevated at 8 mg/L

Rheumatoid Factor (RF): Positive

Anti-Cyclic Citrullinated Peptide (Anti-CCP): Positive

Differential Diagnoses:
Rheumatoid arthritis

Hip osteoarthritis

Polymyalgia rheumatica

Stations:
Station 6: Reading - You have 4 minutes to develop your management plan for this patient.

Station 7: You have 4 minutes to communicate the diagnosis and appropriate management
to the patient.

Station 8: You have 2 minutes to plan your interventions. (Osteo treatment and rehab).

Station 9: You have 6 minutes to perform 1 HVLA technique and any other osteopathic
technique of your choice.

Case 2

Patient Information:
Name: Patient 2
Age: 32

Gender: Female

Occupation: Retail manager

Hobbies: Yoga, gardening

Chief Complaint: Right-sided hip pain and generalized fatigue

Clinical History:
Crystal Steele presents with right-sided hip pain that started insidiously about 8 months
ago. The pain has progressively worsened and now radiates to her right knee and lower
back. She also reports generalized fatigue, joint stiffness, and swelling in her hands and feet,
particularly in the mornings. Crystal has been experiencing these systemic symptoms for
about a year, but they have become more pronounced over the last few months. She has lost
5 kg unintentionally over the past 6 months and feels increasingly fatigued, with occasional
episodes of low-grade fever.

Medical History:
Hypertension: Diagnosed 5 years ago, well-controlled with medication.

Diabetes Mellitus Type 2: Diagnosed 3 years ago, managed with diet and oral
hypoglycemics.

Family History: Mother had rheumatoid arthritis.

Medications:
Metformin

Lisinopril

Occasional use of NSAIDs for pain

Social History:
Non-smoker

Rare alcohol consumption

Active lifestyle, enjoys yoga and gardening

Physical Examination Findings:

Mild pallor, no jaundice.

Vital Signs:
Blood pressure: 135/85 mmHg

Heart rate: 78 bpm

Respiratory rate: 16 breaths per minute

Temperature: 37.5°C

Musculoskeletal:
Hip:

AROM: Decreased flexion and abduction on the right, limited by pain.

PROM: Pain and restriction in flexion and internal rotation.

AR-ROM: Grade 3/5 in right hip flexion with pain.

Knee:

AROM: Decreased flexion and extension on the right.

PROM: Pain and restriction in extension.

AR-ROM: Grade 4/5 in right knee flexion with mild pain.

Orthopaedic Tests:

Positive Faber's test on the right.

Positive Trendelenburg sign.

Neurological:
Decreased sensation in the right L2-L3 dermatome.

Mild weakness in the right quadriceps.

Reflexes: Normal patellar and Achilles reflexes.

Systemic Examination:
Cardiovascular: Normal heart sounds, no murmurs.

Respiratory: Clear breath sounds, no wheezes or crackles.

Abdominal: Soft, non-tender, no organomegaly.

Skin: Warm, dry, no rashes or lesions.

Diagnostic Imaging Report:

Findings:

X-ray of the hip shows joint space narrowing and osteophyte formation consistent with
osteoarthritis.

MRI of the lumbar spine reveals degenerative disc disease at L4-L5 with mild disc bulging.
Conclusion:

Right hip osteoarthritis

Lumbar degenerative disc disease

Lab Results:
Complete Blood Count (CBC): Mild anemia (Hb: 10.5 g/dL)

Erythrocyte Sedimentation Rate (ESR): Elevated at 35 mm/hr

C-Reactive Protein (CRP): Elevated at 8 mg/L

Rheumatoid Factor (RF): Positive

Anti-Cyclic Citrullinated Peptide (Anti-CCP): Positive

Differential Diagnoses:
Rheumatoid arthritis

Hip osteoarthritis

Polymyalgia rheumatica

Stations:
Station 6: Reading - You have 4 minutes to develop your management plan for this patient.

Station 7: You have 4 minutes to communicate the diagnosis and appropriate management
to the patient.

Station 8: You have 2 minutes to plan your interventions. (Osteo treatment and rehab).

Station 9: You have 6 minutes to perform 1 HVLA technique and any other osteopathic
technique of your choice.

Case 3

Patient Information:
Name: Patient 3

Age: 33

Gender: Male

Occupation: Retail manager

Hobbies: Yoga, gardening

Chief Complaint: Right-sided hip pain and generalized fatigue

Clinical History:
Crystal Steele presents with right-sided hip pain that started insidiously about 8 months
ago. The pain has progressively worsened and now radiates to her right knee and lower
back. She also reports generalized fatigue, joint stiffness, and swelling in her hands and feet,
particularly in the mornings. Crystal has been experiencing these systemic symptoms for
about a year, but they have become more pronounced over the last few months. She has lost
5 kg unintentionally over the past 6 months and feels increasingly fatigued, with occasional
episodes of low-grade fever.

Medical History:
Hypertension: Diagnosed 5 years ago, well-controlled with medication.

Diabetes Mellitus Type 2: Diagnosed 3 years ago, managed with diet and oral
hypoglycemics.

Family History: Mother had rheumatoid arthritis.

Medications:
Metformin

Lisinopril

Occasional use of NSAIDs for pain

Social History:
Non-smoker

Rare alcohol consumption

Active lifestyle, enjoys yoga and gardening

Physical Examination Findings:

Mild pallor, no jaundice.

Vital Signs:
Blood pressure: 135/85 mmHg

Heart rate: 78 bpm

Respiratory rate: 16 breaths per minute

Temperature: 37.5°C

Musculoskeletal:
Hip:
AROM: Decreased flexion and abduction on the right, limited by pain.

PROM: Pain and restriction in flexion and internal rotation.

AR-ROM: Grade 3/5 in right hip flexion with pain.

Knee:

AROM: Decreased flexion and extension on the right.

PROM: Pain and restriction in extension.

AR-ROM: Grade 4/5 in right knee flexion with mild pain.

Orthopaedic Tests:

Positive Faber's test on the right.

Positive Trendelenburg sign.

Neurological:
Decreased sensation in the right L2-L3 dermatome.

Mild weakness in the right quadriceps.

Reflexes: Normal patellar and Achilles reflexes.

Systemic Examination:
Cardiovascular: Normal heart sounds, no murmurs.

Respiratory: Clear breath sounds, no wheezes or crackles.

Abdominal: Soft, non-tender, no organomegaly.

Skin: Warm, dry, no rashes or lesions.

Diagnostic Imaging Report:

Findings:

X-ray of the hip shows joint space narrowing and osteophyte formation consistent with
osteoarthritis.

MRI of the lumbar spine reveals degenerative disc disease at L4-L5 with mild disc bulging.

Conclusion:

Right hip osteoarthritis

Lumbar degenerative disc disease

Lab Results:
Complete Blood Count (CBC): Mild anemia (Hb: 10.5 g/dL)

Erythrocyte Sedimentation Rate (ESR): Elevated at 35 mm/hr

C-Reactive Protein (CRP): Elevated at 8 mg/L

Rheumatoid Factor (RF): Positive

Anti-Cyclic Citrullinated Peptide (Anti-CCP): Positive

Differential Diagnoses:
Rheumatoid arthritis

Hip osteoarthritis

Polymyalgia rheumatica

Stations:
Station 6: Reading - You have 4 minutes to develop your management plan for this patient.

Station 7: You have 4 minutes to communicate the diagnosis and appropriate management
to the patient.

Station 8: You have 2 minutes to plan your interventions. (Osteo treatment and rehab).

Station 9: You have 6 minutes to perform 1 HVLA technique and any other osteopathic
technique of your choice.

Case 4

Patient Information:
Name: Patient 4

Age: 34

Gender: Female

Occupation: Retail manager

Hobbies: Yoga, gardening

Chief Complaint: Right-sided hip pain and generalized fatigue

Clinical History:
Crystal Steele presents with right-sided hip pain that started insidiously about 8 months
ago. The pain has progressively worsened and now radiates to her right knee and lower
back. She also reports generalized fatigue, joint stiffness, and swelling in her hands and feet,
particularly in the mornings. Crystal has been experiencing these systemic symptoms for
about a year, but they have become more pronounced over the last few months. She has lost
5 kg unintentionally over the past 6 months and feels increasingly fatigued, with occasional
episodes of low-grade fever.

Medical History:
Hypertension: Diagnosed 5 years ago, well-controlled with medication.

Diabetes Mellitus Type 2: Diagnosed 3 years ago, managed with diet and oral
hypoglycemics.

Family History: Mother had rheumatoid arthritis.

Medications:
Metformin

Lisinopril

Occasional use of NSAIDs for pain

Social History:
Non-smoker

Rare alcohol consumption

Active lifestyle, enjoys yoga and gardening

Physical Examination Findings:

Mild pallor, no jaundice.

Vital Signs:
Blood pressure: 135/85 mmHg

Heart rate: 78 bpm

Respiratory rate: 16 breaths per minute

Temperature: 37.5°C

Musculoskeletal:
Hip:

AROM: Decreased flexion and abduction on the right, limited by pain.

PROM: Pain and restriction in flexion and internal rotation.

AR-ROM: Grade 3/5 in right hip flexion with pain.

Knee:

AROM: Decreased flexion and extension on the right.

PROM: Pain and restriction in extension.

AR-ROM: Grade 4/5 in right knee flexion with mild pain.

Orthopaedic Tests:

Positive Faber's test on the right.

Positive Trendelenburg sign.

Neurological:
Decreased sensation in the right L2-L3 dermatome.

Mild weakness in the right quadriceps.

Reflexes: Normal patellar and Achilles reflexes.

Systemic Examination:
Cardiovascular: Normal heart sounds, no murmurs.

Respiratory: Clear breath sounds, no wheezes or crackles.

Abdominal: Soft, non-tender, no organomegaly.

Skin: Warm, dry, no rashes or lesions.

Diagnostic Imaging Report:

Findings:

X-ray of the hip shows joint space narrowing and osteophyte formation consistent with
osteoarthritis.

MRI of the lumbar spine reveals degenerative disc disease at L4-L5 with mild disc bulging.

Conclusion:

Right hip osteoarthritis

Lumbar degenerative disc disease

Lab Results:
Complete Blood Count (CBC): Mild anemia (Hb: 10.5 g/dL)

Erythrocyte Sedimentation Rate (ESR): Elevated at 35 mm/hr

C-Reactive Protein (CRP): Elevated at 8 mg/L

Rheumatoid Factor (RF): Positive

Anti-Cyclic Citrullinated Peptide (Anti-CCP): Positive

Differential Diagnoses:
Rheumatoid arthritis

Hip osteoarthritis

Polymyalgia rheumatica

Stations:
Station 6: Reading - You have 4 minutes to develop your management plan for this patient.

Station 7: You have 4 minutes to communicate the diagnosis and appropriate management
to the patient.

Station 8: You have 2 minutes to plan your interventions. (Osteo treatment and rehab).

Station 9: You have 6 minutes to perform 1 HVLA technique and any other osteopathic
technique of your choice.

Case 5

Patient Information:
Name: Patient 5

Age: 35

Gender: Male

Occupation: Retail manager

Hobbies: Yoga, gardening

Chief Complaint: Right-sided hip pain and generalized fatigue

Clinical History:
Crystal Steele presents with right-sided hip pain that started insidiously about 8 months
ago. The pain has progressively worsened and now radiates to her right knee and lower
back. She also reports generalized fatigue, joint stiffness, and swelling in her hands and feet,
particularly in the mornings. Crystal has been experiencing these systemic symptoms for
about a year, but they have become more pronounced over the last few months. She has lost
5 kg unintentionally over the past 6 months and feels increasingly fatigued, with occasional
episodes of low-grade fever.
Medical History:
Hypertension: Diagnosed 5 years ago, well-controlled with medication.

Diabetes Mellitus Type 2: Diagnosed 3 years ago, managed with diet and oral
hypoglycemics.

Family History: Mother had rheumatoid arthritis.

Medications:
Metformin

Lisinopril

Occasional use of NSAIDs for pain

Social History:
Non-smoker

Rare alcohol consumption

Active lifestyle, enjoys yoga and gardening

Physical Examination Findings:

Mild pallor, no jaundice.

Vital Signs:
Blood pressure: 135/85 mmHg

Heart rate: 78 bpm

Respiratory rate: 16 breaths per minute

Temperature: 37.5°C

Musculoskeletal:
Hip:

AROM: Decreased flexion and abduction on the right, limited by pain.

PROM: Pain and restriction in flexion and internal rotation.

AR-ROM: Grade 3/5 in right hip flexion with pain.

Knee:

AROM: Decreased flexion and extension on the right.

PROM: Pain and restriction in extension.

AR-ROM: Grade 4/5 in right knee flexion with mild pain.

Orthopaedic Tests:

Positive Faber's test on the right.

Positive Trendelenburg sign.

Neurological:
Decreased sensation in the right L2-L3 dermatome.

Mild weakness in the right quadriceps.

Reflexes: Normal patellar and Achilles reflexes.

Systemic Examination:
Cardiovascular: Normal heart sounds, no murmurs.

Respiratory: Clear breath sounds, no wheezes or crackles.

Abdominal: Soft, non-tender, no organomegaly.

Skin: Warm, dry, no rashes or lesions.

Diagnostic Imaging Report:

Findings:

X-ray of the hip shows joint space narrowing and osteophyte formation consistent with
osteoarthritis.

MRI of the lumbar spine reveals degenerative disc disease at L4-L5 with mild disc bulging.

Conclusion:

Right hip osteoarthritis

Lumbar degenerative disc disease

Lab Results:
Complete Blood Count (CBC): Mild anemia (Hb: 10.5 g/dL)

Erythrocyte Sedimentation Rate (ESR): Elevated at 35 mm/hr

C-Reactive Protein (CRP): Elevated at 8 mg/L

Rheumatoid Factor (RF): Positive

Anti-Cyclic Citrullinated Peptide (Anti-CCP): Positive

Differential Diagnoses:
Rheumatoid arthritis

Hip osteoarthritis

Polymyalgia rheumatica

Stations:
Station 6: Reading - You have 4 minutes to develop your management plan for this patient.

Station 7: You have 4 minutes to communicate the diagnosis and appropriate management
to the patient.

Station 8: You have 2 minutes to plan your interventions. (Osteo treatment and rehab).

Station 9: You have 6 minutes to perform 1 HVLA technique and any other osteopathic
technique of your choice.

Case 6

Patient Information:
Name: Patient 6

Age: 36

Gender: Female

Occupation: Retail manager

Hobbies: Yoga, gardening

Chief Complaint: Right-sided hip pain and generalized fatigue

Clinical History:
Crystal Steele presents with right-sided hip pain that started insidiously about 8 months
ago. The pain has progressively worsened and now radiates to her right knee and lower
back. She also reports generalized fatigue, joint stiffness, and swelling in her hands and feet,
particularly in the mornings. Crystal has been experiencing these systemic symptoms for
about a year, but they have become more pronounced over the last few months. She has lost
5 kg unintentionally over the past 6 months and feels increasingly fatigued, with occasional
episodes of low-grade fever.

Medical History:
Hypertension: Diagnosed 5 years ago, well-controlled with medication.
Diabetes Mellitus Type 2: Diagnosed 3 years ago, managed with diet and oral
hypoglycemics.

Family History: Mother had rheumatoid arthritis.

Medications:
Metformin

Lisinopril

Occasional use of NSAIDs for pain

Social History:
Non-smoker

Rare alcohol consumption

Active lifestyle, enjoys yoga and gardening

Physical Examination Findings:

Mild pallor, no jaundice.

Vital Signs:
Blood pressure: 135/85 mmHg

Heart rate: 78 bpm

Respiratory rate: 16 breaths per minute

Temperature: 37.5°C

Musculoskeletal:
Hip:

AROM: Decreased flexion and abduction on the right, limited by pain.

PROM: Pain and restriction in flexion and internal rotation.

AR-ROM: Grade 3/5 in right hip flexion with pain.

Knee:

AROM: Decreased flexion and extension on the right.

PROM: Pain and restriction in extension.

AR-ROM: Grade 4/5 in right knee flexion with mild pain.

Orthopaedic Tests:
Positive Faber's test on the right.

Positive Trendelenburg sign.

Neurological:
Decreased sensation in the right L2-L3 dermatome.

Mild weakness in the right quadriceps.

Reflexes: Normal patellar and Achilles reflexes.

Systemic Examination:
Cardiovascular: Normal heart sounds, no murmurs.

Respiratory: Clear breath sounds, no wheezes or crackles.

Abdominal: Soft, non-tender, no organomegaly.

Skin: Warm, dry, no rashes or lesions.

Diagnostic Imaging Report:

Findings:

X-ray of the hip shows joint space narrowing and osteophyte formation consistent with
osteoarthritis.

MRI of the lumbar spine reveals degenerative disc disease at L4-L5 with mild disc bulging.

Conclusion:

Right hip osteoarthritis

Lumbar degenerative disc disease

Lab Results:
Complete Blood Count (CBC): Mild anemia (Hb: 10.5 g/dL)

Erythrocyte Sedimentation Rate (ESR): Elevated at 35 mm/hr

C-Reactive Protein (CRP): Elevated at 8 mg/L

Rheumatoid Factor (RF): Positive

Anti-Cyclic Citrullinated Peptide (Anti-CCP): Positive

Differential Diagnoses:
Rheumatoid arthritis

Hip osteoarthritis
Polymyalgia rheumatica

Stations:
Station 6: Reading - You have 4 minutes to develop your management plan for this patient.

Station 7: You have 4 minutes to communicate the diagnosis and appropriate management
to the patient.

Station 8: You have 2 minutes to plan your interventions. (Osteo treatment and rehab).

Station 9: You have 6 minutes to perform 1 HVLA technique and any other osteopathic
technique of your choice.

Case 7

Patient Information:
Name: Patient 7

Age: 37

Gender: Male

Occupation: Retail manager

Hobbies: Yoga, gardening

Chief Complaint: Right-sided hip pain and generalized fatigue

Clinical History:
Crystal Steele presents with right-sided hip pain that started insidiously about 8 months
ago. The pain has progressively worsened and now radiates to her right knee and lower
back. She also reports generalized fatigue, joint stiffness, and swelling in her hands and feet,
particularly in the mornings. Crystal has been experiencing these systemic symptoms for
about a year, but they have become more pronounced over the last few months. She has lost
5 kg unintentionally over the past 6 months and feels increasingly fatigued, with occasional
episodes of low-grade fever.

Medical History:
Hypertension: Diagnosed 5 years ago, well-controlled with medication.

Diabetes Mellitus Type 2: Diagnosed 3 years ago, managed with diet and oral
hypoglycemics.

Family History: Mother had rheumatoid arthritis.

Medications:
Metformin

Lisinopril

Occasional use of NSAIDs for pain

Social History:
Non-smoker

Rare alcohol consumption

Active lifestyle, enjoys yoga and gardening

Physical Examination Findings:

Mild pallor, no jaundice.

Vital Signs:
Blood pressure: 135/85 mmHg

Heart rate: 78 bpm

Respiratory rate: 16 breaths per minute

Temperature: 37.5°C

Musculoskeletal:
Hip:

AROM: Decreased flexion and abduction on the right, limited by pain.

PROM: Pain and restriction in flexion and internal rotation.

AR-ROM: Grade 3/5 in right hip flexion with pain.

Knee:

AROM: Decreased flexion and extension on the right.

PROM: Pain and restriction in extension.

AR-ROM: Grade 4/5 in right knee flexion with mild pain.

Orthopaedic Tests:

Positive Faber's test on the right.

Positive Trendelenburg sign.

Neurological:
Decreased sensation in the right L2-L3 dermatome.

Mild weakness in the right quadriceps.

Reflexes: Normal patellar and Achilles reflexes.

Systemic Examination:
Cardiovascular: Normal heart sounds, no murmurs.

Respiratory: Clear breath sounds, no wheezes or crackles.

Abdominal: Soft, non-tender, no organomegaly.

Skin: Warm, dry, no rashes or lesions.

Diagnostic Imaging Report:

Findings:

X-ray of the hip shows joint space narrowing and osteophyte formation consistent with
osteoarthritis.

MRI of the lumbar spine reveals degenerative disc disease at L4-L5 with mild disc bulging.

Conclusion:

Right hip osteoarthritis

Lumbar degenerative disc disease

Lab Results:
Complete Blood Count (CBC): Mild anemia (Hb: 10.5 g/dL)

Erythrocyte Sedimentation Rate (ESR): Elevated at 35 mm/hr

C-Reactive Protein (CRP): Elevated at 8 mg/L

Rheumatoid Factor (RF): Positive

Anti-Cyclic Citrullinated Peptide (Anti-CCP): Positive

Differential Diagnoses:
Rheumatoid arthritis

Hip osteoarthritis

Polymyalgia rheumatica
Stations:
Station 6: Reading - You have 4 minutes to develop your management plan for this patient.

Station 7: You have 4 minutes to communicate the diagnosis and appropriate management
to the patient.

Station 8: You have 2 minutes to plan your interventions. (Osteo treatment and rehab).

Station 9: You have 6 minutes to perform 1 HVLA technique and any other osteopathic
technique of your choice.

Case 8

Patient Information:
Name: Patient 8

Age: 38

Gender: Female

Occupation: Retail manager

Hobbies: Yoga, gardening

Chief Complaint: Right-sided hip pain and generalized fatigue

Clinical History:
Crystal Steele presents with right-sided hip pain that started insidiously about 8 months
ago. The pain has progressively worsened and now radiates to her right knee and lower
back. She also reports generalized fatigue, joint stiffness, and swelling in her hands and feet,
particularly in the mornings. Crystal has been experiencing these systemic symptoms for
about a year, but they have become more pronounced over the last few months. She has lost
5 kg unintentionally over the past 6 months and feels increasingly fatigued, with occasional
episodes of low-grade fever.

Medical History:
Hypertension: Diagnosed 5 years ago, well-controlled with medication.

Diabetes Mellitus Type 2: Diagnosed 3 years ago, managed with diet and oral
hypoglycemics.

Family History: Mother had rheumatoid arthritis.

Medications:
Metformin
Lisinopril

Occasional use of NSAIDs for pain

Social History:
Non-smoker

Rare alcohol consumption

Active lifestyle, enjoys yoga and gardening

Physical Examination Findings:

Mild pallor, no jaundice.

Vital Signs:
Blood pressure: 135/85 mmHg

Heart rate: 78 bpm

Respiratory rate: 16 breaths per minute

Temperature: 37.5°C

Musculoskeletal:
Hip:

AROM: Decreased flexion and abduction on the right, limited by pain.

PROM: Pain and restriction in flexion and internal rotation.

AR-ROM: Grade 3/5 in right hip flexion with pain.

Knee:

AROM: Decreased flexion and extension on the right.

PROM: Pain and restriction in extension.

AR-ROM: Grade 4/5 in right knee flexion with mild pain.

Orthopaedic Tests:

Positive Faber's test on the right.

Positive Trendelenburg sign.

Neurological:
Decreased sensation in the right L2-L3 dermatome.

Mild weakness in the right quadriceps.

Reflexes: Normal patellar and Achilles reflexes.

Systemic Examination:
Cardiovascular: Normal heart sounds, no murmurs.

Respiratory: Clear breath sounds, no wheezes or crackles.

Abdominal: Soft, non-tender, no organomegaly.

Skin: Warm, dry, no rashes or lesions.

Diagnostic Imaging Report:

Findings:

X-ray of the hip shows joint space narrowing and osteophyte formation consistent with
osteoarthritis.

MRI of the lumbar spine reveals degenerative disc disease at L4-L5 with mild disc bulging.

Conclusion:

Right hip osteoarthritis

Lumbar degenerative disc disease

Lab Results:
Complete Blood Count (CBC): Mild anemia (Hb: 10.5 g/dL)

Erythrocyte Sedimentation Rate (ESR): Elevated at 35 mm/hr

C-Reactive Protein (CRP): Elevated at 8 mg/L

Rheumatoid Factor (RF): Positive

Anti-Cyclic Citrullinated Peptide (Anti-CCP): Positive

Differential Diagnoses:
Rheumatoid arthritis

Hip osteoarthritis

Polymyalgia rheumatica

Stations:
Station 6: Reading - You have 4 minutes to develop your management plan for this patient.

Station 7: You have 4 minutes to communicate the diagnosis and appropriate management
to the patient.
Station 8: You have 2 minutes to plan your interventions. (Osteo treatment and rehab).

Station 9: You have 6 minutes to perform 1 HVLA technique and any other osteopathic
technique of your choice.

Case 9

Patient Information:
Name: Patient 9

Age: 39

Gender: Male

Occupation: Retail manager

Hobbies: Yoga, gardening

Chief Complaint: Right-sided hip pain and generalized fatigue

Clinical History:
Crystal Steele presents with right-sided hip pain that started insidiously about 8 months
ago. The pain has progressively worsened and now radiates to her right knee and lower
back. She also reports generalized fatigue, joint stiffness, and swelling in her hands and feet,
particularly in the mornings. Crystal has been experiencing these systemic symptoms for
about a year, but they have become more pronounced over the last few months. She has lost
5 kg unintentionally over the past 6 months and feels increasingly fatigued, with occasional
episodes of low-grade fever.

Medical History:
Hypertension: Diagnosed 5 years ago, well-controlled with medication.

Diabetes Mellitus Type 2: Diagnosed 3 years ago, managed with diet and oral
hypoglycemics.

Family History: Mother had rheumatoid arthritis.

Medications:
Metformin

Lisinopril

Occasional use of NSAIDs for pain

Social History:
Non-smoker
Rare alcohol consumption

Active lifestyle, enjoys yoga and gardening

Physical Examination Findings:

Mild pallor, no jaundice.

Vital Signs:
Blood pressure: 135/85 mmHg

Heart rate: 78 bpm

Respiratory rate: 16 breaths per minute

Temperature: 37.5°C

Musculoskeletal:
Hip:

AROM: Decreased flexion and abduction on the right, limited by pain.

PROM: Pain and restriction in flexion and internal rotation.

AR-ROM: Grade 3/5 in right hip flexion with pain.

Knee:

AROM: Decreased flexion and extension on the right.

PROM: Pain and restriction in extension.

AR-ROM: Grade 4/5 in right knee flexion with mild pain.

Orthopaedic Tests:

Positive Faber's test on the right.

Positive Trendelenburg sign.

Neurological:
Decreased sensation in the right L2-L3 dermatome.

Mild weakness in the right quadriceps.

Reflexes: Normal patellar and Achilles reflexes.

Systemic Examination:
Cardiovascular: Normal heart sounds, no murmurs.

Respiratory: Clear breath sounds, no wheezes or crackles.

Abdominal: Soft, non-tender, no organomegaly.

Skin: Warm, dry, no rashes or lesions.

Diagnostic Imaging Report:

Findings:

X-ray of the hip shows joint space narrowing and osteophyte formation consistent with
osteoarthritis.

MRI of the lumbar spine reveals degenerative disc disease at L4-L5 with mild disc bulging.

Conclusion:

Right hip osteoarthritis

Lumbar degenerative disc disease

Lab Results:
Complete Blood Count (CBC): Mild anemia (Hb: 10.5 g/dL)

Erythrocyte Sedimentation Rate (ESR): Elevated at 35 mm/hr

C-Reactive Protein (CRP): Elevated at 8 mg/L

Rheumatoid Factor (RF): Positive

Anti-Cyclic Citrullinated Peptide (Anti-CCP): Positive

Differential Diagnoses:
Rheumatoid arthritis

Hip osteoarthritis

Polymyalgia rheumatica

Stations:
Station 6: Reading - You have 4 minutes to develop your management plan for this patient.

Station 7: You have 4 minutes to communicate the diagnosis and appropriate management
to the patient.

Station 8: You have 2 minutes to plan your interventions. (Osteo treatment and rehab).

Station 9: You have 6 minutes to perform 1 HVLA technique and any other osteopathic
technique of your choice.
Case 10

Patient Information:
Name: Patient 10

Age: 40

Gender: Female

Occupation: Retail manager

Hobbies: Yoga, gardening

Chief Complaint: Right-sided hip pain and generalized fatigue

Clinical History:
Crystal Steele presents with right-sided hip pain that started insidiously about 8 months
ago. The pain has progressively worsened and now radiates to her right knee and lower
back. She also reports generalized fatigue, joint stiffness, and swelling in her hands and feet,
particularly in the mornings. Crystal has been experiencing these systemic symptoms for
about a year, but they have become more pronounced over the last few months. She has lost
5 kg unintentionally over the past 6 months and feels increasingly fatigued, with occasional
episodes of low-grade fever.

Medical History:
Hypertension: Diagnosed 5 years ago, well-controlled with medication.

Diabetes Mellitus Type 2: Diagnosed 3 years ago, managed with diet and oral
hypoglycemics.

Family History: Mother had rheumatoid arthritis.

Medications:
Metformin

Lisinopril

Occasional use of NSAIDs for pain

Social History:
Non-smoker

Rare alcohol consumption

Active lifestyle, enjoys yoga and gardening

Physical Examination Findings:
Mild pallor, no jaundice.

Vital Signs:
Blood pressure: 135/85 mmHg

Heart rate: 78 bpm

Respiratory rate: 16 breaths per minute

Temperature: 37.5°C

Musculoskeletal:
Hip:

AROM: Decreased flexion and abduction on the right, limited by pain.

PROM: Pain and restriction in flexion and internal rotation.

AR-ROM: Grade 3/5 in right hip flexion with pain.

Knee:

AROM: Decreased flexion and extension on the right.

PROM: Pain and restriction in extension.

AR-ROM: Grade 4/5 in right knee flexion with mild pain.

Orthopaedic Tests:

Positive Faber's test on the right.

Positive Trendelenburg sign.

Neurological:
Decreased sensation in the right L2-L3 dermatome.

Mild weakness in the right quadriceps.

Reflexes: Normal patellar and Achilles reflexes.

Systemic Examination:
Cardiovascular: Normal heart sounds, no murmurs.

Respiratory: Clear breath sounds, no wheezes or crackles.

Abdominal: Soft, non-tender, no organomegaly.

Skin: Warm, dry, no rashes or lesions.

Diagnostic Imaging Report:
Findings:

X-ray of the hip shows joint space narrowing and osteophyte formation consistent with
osteoarthritis.

MRI of the lumbar spine reveals degenerative disc disease at L4-L5 with mild disc bulging.

Conclusion:

Right hip osteoarthritis

Lumbar degenerative disc disease

Lab Results:
Complete Blood Count (CBC): Mild anemia (Hb: 10.5 g/dL)

Erythrocyte Sedimentation Rate (ESR): Elevated at 35 mm/hr

C-Reactive Protein (CRP): Elevated at 8 mg/L

Rheumatoid Factor (RF): Positive

Anti-Cyclic Citrullinated Peptide (Anti-CCP): Positive

Differential Diagnoses:
Rheumatoid arthritis

Hip osteoarthritis

Polymyalgia rheumatica

Stations:
Station 6: Reading - You have 4 minutes to develop your management plan for this patient.

Station 7: You have 4 minutes to communicate the diagnosis and appropriate management
to the patient.

Station 8: You have 2 minutes to plan your interventions. (Osteo treatment and rehab).

Station 9: You have 6 minutes to perform 1 HVLA technique and any other osteopathic
technique of your choice.