72 Differential Diagnosis in Physical Therapy of Upper Extremity and Lower Quadrant: Summary
CASE STUDY
Patient is 67-year-old female who presents to clinic with complaint of right UE pain and weakness 5 months post cervical laminectomy. Patient was referred to therapy for ROM and strength training. Patient had been receiving home health physical therapy after her surgery and stated that therapy was progressing well until therapist “forced her UE into supination” and she felt pain. She further states that she has not been able to have a functional grasp since that time and has increased weakness, pain and swelling in her right UE. Patient reports that surgery must have affected her vocal cords and she is currently seeing a speech therapist.
Evaluation Impairments in ADL function, joint integrity/mobility, strength, ROM, pain, swelling, stiffness. Yellow/red flags • Joint pain, redness, warmth, swelling, stiffness • Weakness in bilateral UEs Differential Diagnosis • CRPS, fracture, sprain/strain ○ X-rays: Negative for fracture Treatment Edema and pain reduction, ROM, strengthening. Re-evaluation (4 weeks) Edema resolved in right wrist/hand but minimal strength gains right UE only. Patient with complaint of weakness bilateral UE getting in the way of her ADLs. Also reports decreased balance and endurance. Result Patient was referred by neurologist to MD Anderson. After muscle biopsy, patient diagnosed with ALS. • Home evaluation • Wheelchair prescription • Home exercise program—stretching • Patient/caregiver education Review of Systemic Signs/Symptoms • Insidious onset • Cyclic presentation of symptoms • Pain unrelieved by rest • Symptoms that persist beyond time of recovery • Out of proportion symptoms • Pallor • Dizziness/syncope • Fatigue • Weight loss
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• Constitutional symptoms -fever, malaise, diaphoresis, nausea/vomiting, pallor, weight loss, fatigue • Bilateral symptomology Review of Constitutional Symptoms: • Fever • Diaphoresis • Sweats (can occur anytime night or day) • Nausea/vomiting • Diarrhea
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