Differential Diagnosis for Physical Therapy: Cancer, Hepatic/Biliary, and Renal Disease: Summary 100 GU System Signs/Symptoms
• Reduced stream, decreased output • Burning or bleeding during urination; change in urine color • Urinary incontinence, dribbling
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• Hesitation, urgency • Nocturia, frequency • Testicular pain or swelling • Flank pain
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CASE STUDY
The patient is an 83-year-old white male with a history of radical neck dissection with radiation in 1993. He now presents to therapy with cervicalgia and muscular wasting/ disuse atrophy. He denies trauma or falls. PET scan 2015—displayed no present lesions. Patient was also referred to pain doctor for nonsurgical interventional treatment. MD recommended greater occipital nerve block and therapy for pain reduction, ROM, and strength training.
Examination Findings • Past medical history (MHX): Oral cavity squamous cell CA with partial mandibulectomy and radical neck dissection • Social history: Nonsmoker, nondrinker • Family MHX: Maternal—Alzheimer’s, paternal—heart failure • Meds: Synthroid 100 mg, testosterone (gel), Prednisone 60 mg, hydrocodone 10 mg • Clinical presentation ○ Review of systems: Patient reports hearing loss and ringing in ears as well as fatigue; denies recent weight loss ○ Vitals: BP: 119/72; HR: 61 • Integumentary—significant postsurgical cervical scars on L- L sternocleidomastoid muscle resection • Cognition: A&O × 4 • Palpation: Tender to palpation R upper trapezius • Posture: Cervical—reduced lordosis and fixed tilt to R 13 degrees • ROM: Cervical limited—40% R rotation, 20% R side bending, 30% L rotation, 40% side bending • Pain (NPS): Varies from 4 to 8/10 • Strength ○ B LE: 4/5 ○ R UE: Shoulder flexion and abduction 3+/5 ○ L UE: Shoulder flexion 4/5 and abduction 3-/5 ■ Scapular elevation/retraction 2-/5 • Cervical: L rotation 3+/5, L side bending 3-/5 • 5 sit to stand: 12.1 seconds • Sensation: Dysthesia L posterior auricular and L occipital area • Reflexes: CN XI injury/UE/LE: 2+ throughout
• Endurance: 6-minute walk test—1,200 feet with BORG of 6 • Participation: Neck Disability Index—20/50 = 40% disabled Evaluation Patient presents with neck and head pain that is limiting function and ability to sleep. Also with complaint of fatigue. Patient displays poor cervical posture, decreased ROM, and weakness • Yellow/red flags ○ Previous CA history Treatment • Pain reduction • ROM • Postural training • Strength training • Home exercise program—torticollis splint Re-evaluation (4 weeks) ROM improved but pain and paresthesia
remained unchanged Differential Diagnosis • Visceral? • CA? Referrals
• MD Result
Patient seen by physician and another work-up was done along with new MRI; patient diagnosed with metastatic throat CA
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