63
Differential Diagnosis in Physical Therapy of Upper Extremity and Lower Quadrant: Summary
LOWER QUADRANT
Lower Quadrant History • Lower Extremity Functional Scale (LEFS): Questionnaire containing 20 questions about a person’s ability to perform everyday tasks. The LEFS can be used by clinicians as a measure of patients’ initial function, ongoing progress, and outcome, as well as to set functional goals. ○ Interpretation of scores: The lower the score, the greater the disability ○ MDC/MCID: 9 Lower Quadrant Examination • Classic complaint with hip pathology is “groin pain” ○ The patient will cup hand above greater trochanter when describing deep interior hip pain ○ The hand forms a C = “C-sign” • Palpation • Posture • ROM with overpressures • Leg length discrepancies • Neurological ○ DTRs ○ Sensation • Key muscle testing • Squat test • Neurodynamic testing—when appropriate • Muscle length tests ○ Obers ○ Thomas ○ SLR ○ Ely Special Tests • Trendelenburg sign:
Hip Pain Pattern True hip pain is usually felt posteriorly deep within the buttock or anteriorly in the groin, sometimes with radiating pain down the anterior thigh. Pain perceived on lateral side or posterior aspect of the hip is usually not caused by an intra-articular problem but more likely results from a trigger point, knee, SI, or back problem. Causes of Hip/Buttock Pain • Neuromusculoskeletal: ○ Lumbar spine ○ Osteoarthritis ○ Synovitis ○ Bursitis (trochanteric, iliopectineal, iliopsoas, ischial) ○ Fasciitis, myofascial pain ○ Tendinopathy ○ Piriformis syndrome ○ Stress reactions/fractures ○ Peripheral nerve injury or entrapment ○ Implant loosening ○ Acetabular labral or cartilage lesions • Systemic/medical conditions
○ Vascular ○ Urogenital ○ Infectious/inflammatory conditions ○ Ankylosing spondylitis ○ Appendicitis ○ Crohn's disease ○ Diverticulitis ○ Osteomyelitis ○ PID ○ Inflammatory arthritis ○ Septic hip ○ Osteomalacia/osteoporosis ○ Paget’s disease ○ Hemophilia LEARNING TIP! Cancer, such as prostate cancer (men), any reproductive cancers (women), or breast cancer, is a red flag as these cancers may be associated with metastases.
Powered by FlippingBook