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Differential Diagnosis in Physical Therapy of Upper Extremity and Lower Quadrant: Summary
Red Flags Associated with Pelvic Pain or Symptoms • Clinical presentation ○ Insidious onset; unknown cause ○ Poorly localized, diffuse; client unable to point to one spot ○ Aggravated by increased intra- abdominal pressure ○ Not affected by specific movements but gets worse toward the end of the day or after standing for a long time ○ Pelvic pain that is described as “achy” or “comes and goes in waves” and poorly localized ○ Aggravated by walking, sexual intercourse, coughing, or straining ○ Not clearly affected by position changes ○ Not reduced or eliminated by tissue mobilization or release of trigger points Physician Referral • Guidelines for immediate medical attention ○ Signs and symptoms that point to fracture, infection, or neoplasm ○ Suspicion of any infection (e.g., STD, pelvic inflammatory disease [PID]) ○ A sexually active female with shoulder or back pain of unknown cause may need to be screened for ectopic pregnancy ○ Blood after bowel movement ○ Lateral wall pelvic pain referred down the anteromedial side of the thigh to the knee ○ A history of cancer with recent surgical
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.
removal of tumor followed by back, hip, sacral, or pelvic pain within 6 months of surgery is a red flag for possible cancer recurrence LOWER QUADRANT
Hip Pain Pattern True hip pain is usually felt posteriorly deep within the buttock or anteriorly in the
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