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Differential Diagnosis in Physical Therapy of Upper Extremity and Lower Quadrant: Summary
CASE STUDY
Patient is 49-year-old African American female. Patient with diagnosis of bilateral trochanteric bursitis and referred for pain reduction and strengthening. Patient states that she has diffuse muscle and joint pain that is worse in the morning and gets better during the day. She states that her bilateral hip pain started in 2014 and is dull and continual. She states that she also has bouts of fatigue that have made her unable to be compliant with exercising. Additionally, she reports she cannot take anti-inflammatories because she is allergic. She has tried Lyrica in the past, but it didn’t help her pain.
Examination Findings • Past medical history: Various food allergies, allergy to NSAIDS, asthma, cervical dystonia, migraines, OA • Previous therapy: N/A • Medications: Albuterol, Advair, Zyrtec, Benadryl. Botox every 3 months for migraines • Clinical presentation ○ Vitals: BP: 120/72; HR: 82 bpm ○ Integumentary—intact • PROM: Bilateral LE/UE: WNL • Pain (NPS score): Left UE: 5/10 in shoulder and bilateral LE: 3/10 hips • Strength ○ Bilateral UE: 4+/5 ○ Right LE: Knee extension/adduction/ plantar flexion—4/5; dorsiflexion—3+/5; abduction—3+/5 ○ Left LE grossly 5/5 • 5x sit to stand: 10.2 seconds • Sensation: Grossly intact • Reflexes: 2+ bilateral UE/LE • Ober’s: Negative • Thomas Test: Negative • FABER/FADIR: Negative • Jump: Negative • Endurance: 6 minute walk test—1,400 feet with Borg of 6 • Timed up and go: 10 seconds • Participation: LEFS – 70
Evaluation Patient presents with impairments in strength and complaint of pain in B hips and L shoulder. Also complaint of fatigue. Yellow/red flags • Bilateral pain distribution
• Fatigue Treatment • Pain reduction • Endurance training • Strengthening Re-evaluation (2 weeks)
Patient states that she feels stronger. Pain remains unchanged but patient presents with increased endurance and strength. Differential Diagnosis: • Fibromylagia Result Patient seen by physician. After testing, patient diagnosed with RA.
Upper Quadrant • Outcome Measures: ○ Disabilities of the Arm Shoulder and Hand (DASH): Measures physical function/symptoms with multiple UE musculoskeletal disorders ■ MDC = 11.2 ■ MCID = 8
○ American Shoulder and Elbow Surgeons Self-Report (ASES): Condition-specific scale that is intended to measure functional limitations and pain of the shoulder ■ MDC: Diagnosis specific ■ MCID = 6.4 points ○ Shoulder Pain and Disability Index: Measures the impact of shoulder pathology on pain and disability in an outpatient setting
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