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Differential Diagnosis in Physical Therapy of Upper Extremity and Lower Quadrant: Summary
Other Leg Conditions Sciatica: Causes of sciatica can be: • Diskogenic ○ Disk herniation
• Relieving factors: Eliminating caffeine; increasing exercise; medications; stretching; maintain hydration; heat or cold Trauma Cases of Lower Quadrant Pain Stress Reaction or Fracture: Undiagnosed stress fracture is a possible cause of hip, thigh, groin, knee, shin, heel, or foot pain. Exercise—induced groin, tibial, or heel pain are the most common stress fractures. • Two types of stress fractures ○ Insufficiency fractures: Breaks in abnormal bone under normal force, more common in older adults ○ Fatigue fractures: Breaks in normal bone that has been put under extreme force, usually caused by new, strenuous, very repetitive activities such as marching, jumping, or distance running • Depending on age, look for a history of high-energy trauma, prolonged activity, or abrupt increase in training intensity • Other risk factors: ○ Changes in running surface ○ Inadequately cushioned footwear ○ Female athlete triad ○ Radiation/chemotherapy ○ Prolonged use of corticosteroids ○ Metabolic disorders affecting bone • Clinical Signs and Symptoms: Stress Reaction/Stress Fracture ○ Aching pain in hip /groin area; may radiate to knee ○ Increases with activity /improves with rest ○ Compensatory gluteus medius gait ○ Localized tenderness ○ Positive Patrick’s or Faber’s test ○ Thigh pain reproduced by the fulcrum test (femoral shaft fracture) ○ Pain reproduced by weight bearing, heel strike ○ Possible local swelling ○ Night pain (femoral neck stress fracture)
○ LBP with radiculopathy and paravertebral muscle spasm ○ Indicatory findings: Valsalva’s maneuver and sciatic stretch reproduce symptoms • Nondiskogenic ○ Sacroiliitis ■ Low back and buttock pain ■ Tender SI joint; + compression test; + Faber's test ○ Piriformis syndrome ■ LBP and buttock pain with referred pain down the leg to ankle or midfoot ■ Pain and weakness on resisted abduction/external rotation of the thigh • Lateral entrapment syndrome (spinal stenosis) ○ Buttock and leg pain with radiculopathy; pain often relieved by sitting, aggravated by extension of the spine • Trochanteric bursitis ○ Buttock and lateral thigh pain; worse at night and with activity ○ Tender greater trochanter—jump sign Guidelines for Immediate Medical Attention • Painless, progressive enlargement of lymph nodes, for a client with past medical history of cancer • Hip or groin pain alternating or occurring simultaneously with abdominal pain at the same level (aneurysm, colorectal cancer) • Hip or leg pain on weight bearing with positive tests—stress reaction or fracture
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