From the Guidelines
RICE therapy is not indicated for this 83-year-old female patient with right hip pain radiating to the right leg, as the evidence suggests that RICE is not effective for conditions without acute inflammation or injury, and the patient's presentation is more complex, requiring a comprehensive evaluation to identify the underlying cause of the pain. The patient's laboratory results indicate mild anemia (low MCV, MCH, MCHC with elevated RDW) and moderate kidney dysfunction (elevated creatinine, reduced eGFR of 31) 1. The hip X-ray shows no acute fracture, significant arthritic changes, or other structural abnormalities that would typically respond to RICE therapy. Given the radiating nature of the pain and normal hip imaging, the symptoms may be related to a neurological issue such as lumbar radiculopathy, or could be associated with her underlying medical conditions. Some key points to consider in this case include:
- The patient's age and underlying medical conditions, which may contribute to the complexity of the presentation
- The lack of evidence supporting the use of RICE for non-acute injuries or conditions without inflammation, as noted in a study published in the British Journal of Sports Medicine 1
- The need for a comprehensive evaluation, including possible MRI of the lumbar spine, neurological examination, and management of her anemia and kidney disease, to identify the underlying cause of the radiating pain. Treatment should focus on addressing the underlying cause of the pain, rather than symptomatic management with RICE, which is typically reserved for acute musculoskeletal injuries with inflammation.
From the Research
Patient Presentation
The patient is an 83-year-old female presenting with right hip pain that radiates to the right leg. Laboratory tests show:
- CBC: MCV 78.2, MCH 24.2, MCHC 31.0, RDW-CV 16.1
- CMP: Creatinine 1.63, eGFR 31
- Hip X-ray: No significant changes in the appearance of the right hip, no significant arthritic changes or acute fracture/subluxation, soft tissue unremarkable, bone mineralization stable
Differential Diagnosis
Based on the patient's presentation, the differential diagnosis for hip pain includes:
- Intra-articular pathology, such as osteoarthritis and hip labral tears 2, 3
- Extra-articular etiologies, such as hip flexor injuries and greater trochanteric pain syndrome 3
- Referred pain from lumbar spinal pathology, deep gluteal syndrome with sciatic nerve entrapment, ischiofemoral impingement, and hamstring tendinopathy 3
Treatment Options
The patient's treatment options may include:
- Physiotherapist-led interventions, which may improve pain and function in young and middle-aged adults with hip-related pain 4
- Rest, ice, compression, and elevation (RICE) for acute injuries, although its effectiveness in this case is unclear due to the lack of evidence on its use in hip pain management 5
RICE Indication
There is limited evidence to support the use of RICE in the management of hip pain in this patient. The study on RICE 5 focused on its use in patients with ankle fractures, and its application to hip pain is not well established. Therefore, the indication for RICE in this case is unclear, and further evaluation is needed to determine the best course of treatment. 2, 3, 5