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Differential Diagnosis in Physical Therapy of Upper Extremity and Lower Quadrant: Summary
CASE STUDY
The patie nt is a 32-year-old woman whose symptoms began three weeks prior to the initial evaluation when she awoke in the morning with the sudden and severe onset of left-sided sacral pain. Patient stated that onset occurred the day after lifting boxes at work. Patient saw her primary care doctor which ordered both radiographs and an MRI which were negative. She reported constant pain on the left lumbosacral region that occasionally radiated into the left lower abdominal quadrant and left buttock. The pain was worse during ambulation and at the end of the day, and sometimes with coughing and sneezing.
Examination Findings • Past medical history: Intermittent low back pain over the past 2 years • Family history: Fibromyalgia and Type 1 DM (maternal) • Medications: Flexaril, Percocet, birth control pills, multivitamin • Clinical presentation ○ Vitals: BP: 118/75; HR: 85 bpm ○ Integumentary—intact • Palpation: Revealed marked tenderness over the left lower abdominal quadrant and over the left lumbar paraspinal region • Posture: Increased lordosis • ROM: bilateral LE/UE and trunk—WNL • Pain (NPS score): 7/10 at rest, and increased to 9/10 after 30 minutes of standing or walking • Strength: Bilateral LE/UE: 4+/5 • 5x sit to stand: 11 seconds • Sensation: Grossly intact • Reflexes: 2+ bilateral UE/LE • Endurance: 6 minute walk test—1,400 feet with Borg of 3 • Patrick test—negative • Distraction/compression/thigh thrust: negative • Sacral thrust: positive with pain in left flank and SI • Participation: Oswestry Disability Index—38% Lower Quadrant History • Lower Extremity Functional Scale (LEFS): Questionnaire containing 20 questions about a person’s ability to perform everyday tasks. The LEFS can be used by clinicians as a measure of patients’ initial
Evaluation Patient presents with left lumbar and sacral pain which is limiting function.
Yellow/red flags • Pain chronicity • Pain pattern • Pain unrelieved by rest Treatment • Pain reduction • Postural training • Spinal stabilization exercises • Home ex program Re-evaluation (2 weeks)
Patient stated that she has been compliant with home program but she feels pain remained unchanged. Differential Diagnosis • Visceral Result Patient seen by primary care physician and referred to gynecologist and was diagnosed with endometriosis.
function, ongoing progress, and outcome, as well as to set functional goals. ○ Interpretation of scores: The lower the score, the greater the disability ○ MDC/MCID: 9
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