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Differential Diagnosis in Physical Therapy of Upper Extremity and Lower Quadrant: Summary
• Noncapsular pattern of restriction at hip (flexion, abduction, internal rotation) • Resisted hip movements painful and weak, especially hip extension Characteristic Hip Symptoms • Symptoms worse with activities • Twisting, such as turning or changing directions • Seated position may be uncomfortable • Rising from seated position often painful (catching) • Difficulty ascending and descending stairs • Symptoms with entering/exiting an automobile • Difficulty with shoes, socks, hose, etc. Causes of Groin Pain Clinicians may see a client with an isolated groin problem, but more often they present with low back, pelvic, hip, knee, or SI problems with a secondary complaint of groin pain. Systemic and/or visceral causes of groin pain are wide ranging. • Systemic : cancer, osteoporosis, ascites (cirrhosis), hemophilia, gi bleeding, abdominal aortic aneurysm, peripheral arterial aneurysm, uterine fibroids/masses, ovarian cyst, PID, prostate impairment, epididymitis; testicular torsion, urethritis/ urinary tract infection, diverticulitis, inflammatory bowel disease • Neuromusculoskeletal : strain, nerve compression, stress fracture, avulsion fracture, or complete bone fracture, bursitis (iliopectineal), hernia, subluxation, dislocation, avascular necrosis (avn), Legg– Calvé–Perthes disease, labral tear, arthritis, lumbar spine impairment, thoracic disk disease (lower thoracic spine) Causes of Thigh Pain • Neuromusculoskeletal: strains, bursitis, peripheral neuropathy, contusions, nerve compression, femoral shaft or subtrochanteric stress reaction or fracture, hip disease, si joint dysfunction, upper lumbar spine dysfunction;
spondylolisthesis, herniated disk, inguinal hernia • Systemic: retroperitoneal or intraabdominal tumor or abscess, peripheral neuropathy, urethral, chronic alcohol use, thrombosis Symptoms and Differentiation of Leg Pain Vascular Claudication: Pain is usually bilateral with no burning or dysesthesia • Aggravating factors: Pain is brought on by physical exertion; increased by climbing stairs or walking uphill (increased metabolic demand) • Relieving factors: Relieved promptly by standing still, sitting down, or resting (1–5 minutes) Neurogenic Claudication: Pain is usually bilateral but may be unilateral with burning and dysesthesia in the back, buttocks, and/ or leg • Aggravating factors: Increased in spinal extension ; walking—increased by walking downhill (increased lumbar lordosis), less painful when walking uphill • Relieving factors: Pain decreased by sitting, bending forward, or flexion exercises Peripheral Neuropathy: Pain, aching, and numbness of feet with motor, sensory, and autonomic changes: burning, prickling, or tingling may be present; hyperesthesia • Aggravating factors: Depends on underlying cause (e.g., uncontrolled glucose levels with diabetes; progressive alcoholism) • Relieving factors: Pain medications and relaxation techniques; treatment of underlying cause Restless Legs Syndrome: Crawling, creeping sensation in legs with involuntary contractions of calf muscles, occurring especially at night. Pain can be mild to severe, lasting seconds, minutes, or hours • Aggravating factors: Caffeine, pregnancy, iron deficiency
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