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Differential Diagnosis in Physical Therapy of Upper Extremity and Lower Quadrant: Summary
Thoracic Spine Red Flags Renal kidney stones • Renal colic/flank pain • Fever, nausea, and vomiting • Increased risk for kidney infection with ongoing urinary tract infection (UTI) Compression fracture • Caucasian race (continued)
• Sedentary lifestyle • Steroid treatment • Fracture: blunt trauma or injury
• History of smoking • Early menopause • Thin body build
Ankylosing spondylitis • Limited chest expansions, less than 25 cm measured at nipple line • Sacroiliitis
• Morning pain and stiffness • Peripheral joint involvement Cancer • Age over 50 years • Previous history of cancer • Unexplained weight loss LUMBAR SPINE Lumbar Pain/Low Back Pain (LBP)
• Constant pain, no relief with bed rest • Night pain
Clues • Quality of pain • Age • Presence of systemic complaints or associated signs/symptoms indicate the need to investigate further Lumbar History A detailed medical history is the most important element in evaluation of client with musculoskeletal pain of unknown etiology. It is important to ask about the presence of additional signs and symptoms, namely, history of cancer, diabetes (DM), immunosuppression, rheumatologic disorders, and any recent infection. • Medications ○ Check medications for potential side effects causing muscular, joint, neck, or back pain ○ Long-term use of corticosteroids can lead to vertebral compression
Up to 90% of clients will experience an episode of acute back pain at least once during their lifetime. Mechanical LBP and lower extremity (LE) pain with spinal causes account for approximately 97% of all cases. Nonmechanical spinal disease can be attributed to neoplasm infection in 1% of all cases, while 2% are accounted for by visceral disorders. Lumbar pain is most associated with age-related degenerative processes, physical loading, and musculoligamentous injuries. Up to 10% of LBP patients have no identifiable cause. Sacroiliac (SI) joint dysfunction can mimic LBP and discogenic disease with pain referred below the knee to the foot. Studies show SI joint dysfunction is the primary source of LBP, with up to 30% of people with SI joint dysfunction also experiencing LBP pain. Screening for medical disease is an important part of the evaluation process.
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