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Differential Diagnosis for Physical Therapy: Introduction: Summary
Physical Exam • Pain patterns/pain types • Review of systems Signs and symptoms of systemic disease/ Red Flags • Insidious onset • Fever • Cyclic presentation of symptoms • Pain unrelieved by rest • Symptoms that persist beyond time of recovery • Out of proportion symptoms • Bilateral symptomology Pain Patterns Pain patterns of chest, thoracic spine, shoulder, scapula, lumbar spine, groin, sacroiliac joint, and hip are most frequent sites of referred pain from a systemic disease. 1. Cutaneous - (related to skin) ○ Source of pain includes superficial somatic structures located in the skin and subcutaneous tissue ○ Well localized 2. Deep Somatic ○ Sources include bone, nerve, muscle, tendon, ligaments, periosteum, cancellous bone, arteries and joint capsule ○ Poorly localized, may be referred to body surface ○ Can be associated with autonomic phenomenon (sweating, pallor, decreased BP, and is often accompanied by feeling of nausea and faintness) 3. Visceral - sources include all body organs located in the trunk or abdomen ○ Site of pain corresponds to dermatomes from which the diseased organ receives its innervation ○ Not well localized ○ NOTE: visceral pleura membrane is insensitive to pain ○ Until disease involves the parietal pleura, pain may not be experienced by patient ○ Visceral disease of abdomen and pelvis - more likely to refer pain to back ○ Intrathoracic disease -refers pain to shoulders
■ Watch for the four Ds associated with OTC drug use: – Dizziness – Drowsiness – Depression – Visual disturbance ■ Common Side Effects of medications – Skin reactions, non-inflammatory joint pain (antibiotics) – Muscle weakness/cramping (diuretics) – Muscle hyperactivity (caffeine and medications with caffeine) – Back and/or shoulder pain (NSAIDs; retroperitoneal bleeding) – Hip pain from femoral head necrosis (corticosteroids) – Gait disturbances (Thorazine/ tranquilizers) – Movement disorders (anticholinergics, antipsychotics, antidepressants) – Gastrointestinal symptoms (nausea, indigestion, abdominal pain, melena)
• Osteoporsis/Osteopenia • History of Cancer • Heart Disease • Menopause • Immune deficiency • Diet • Recent infection (Upper Respiratory Infection, Urinary Track Infections) • Prolonged time on steroids
Risk Factor Assessment • Substance use/abuse • Tobacco use • Age • Gender • Body mass index (BMI) • Exposure to radiation • Alcohol use/abuse • Sedentary lifestyle • Race/Ethnicity • Occupation
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