66 Differential Diagnosis in Physical Therapy of Upper Extremity and Lower Quadrant: Summary
Other Leg Conditions Sciatica: Causes of sciatica can be: • Diskogenic ○ Disk herniation ○ LBP with radiculopathy and paravertebral muscle spasm ○ Indicatory findings: Valsalva’s maneuver and sciatic stretch reproduce symptoms • Nondiskogenic ○ Sacroiliitis ■ Low back and buttock pain ■ Tender SI joint; + compression test; + Faber's test ○ Piriformis syndrome ■ LBP and buttock pain with referred pain down the leg to ankle or midfoot ■ Pain and weakness on resisted abduction/external rotation of the thigh • Lateral entrapment syndrome (spinal stenosis) ○ Buttock and leg pain with radiculopathy; pain often relieved by sitting, aggravated by extension of the spine • Trochanteric bursitis ○ Buttock and lateral thigh pain; worse at night and with activity ○ Tender greater trochanter—jump sign
Guidelines for Immediate Medical Attention • Painless, progressive enlargement of lymph nodes, for a client with past medical history of cancer • Hip or groin pain alternating or occurring simultaneously with abdominal pain at the same level (aneurysm, colorectal cancer) • Hip or leg pain on weight bearing with positive tests—stress reaction or fracture Guidelines for Physician Referral • Hip, thigh, or buttock pain with a total hip arthroplasty that is brought on by activity but resolves with continued activity (loose prosthesis), or who has persistent pain that is unrelieved by rest (Implant infection) • Sciatica accompanied by extreme motor weakness, numbness in the groin or rectum, or difficulty controlling bowel or bladder function • One or more of Cyriax’s signs of the buttock • New onset of joint pain in a client with a known history of Crohn’s disease, requiring careful screening and possible referral based on examination results
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