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Differential Diagnosis for Physical Therapy: Introduction: Summary
Comparison of Systemic Versus Musculoskeletal Pain Pattern Systemic
• Blood pressure:
○ Optimal: <120/<80 ○ Pre-hypertension: 120-139/80-89 ○ Hypertension: >140/>90 ○ Optimal - 95% to 100% ○ Referral is advised when resting saturation levels fall below 90% ■ Exception -clients with a history of tobacco use and/or COPD ■ COPD could have resting saturations below 90 at baseline ○ Optimal: 15 to 20 breaths per minute ○ < 12 or > 25 breaths per minute abnormal Walking Speed • Assessed best with 10-meter walk test Body Mass Index (BMI) Weight Categories BMI (kg/m²) Underweight <18.5 Healthy Weight 18.5 - 24.9 Overweight 25 - 29.9 Obese 30 - 34.9 Severely Obese 35 - 39.9 Morbidly Obese >40 Integumentary Screening • Examine for changes in texture, color, temperature, clubbing, capillary filling, and edema • Vitiligo skin condition is associated with areas of hypopigmentation • Skin mobility and turgor affected by fluid status of the client ○ Turgor Assessment: • Pulse Oximetry: • Pain (“5th vital sign”) • Respirations (adults)
Musculoskeletal May be sudden or gradual, depending on the history: • Sudden : acute overload stress, traumatic event, repetitive motion; can occur as a side effect of some medications (statins) Secondary to chronic overload of the affected part; may be present off and on for years Usually unilateral May be stiff after prolonged rest, but pain level decreases • Gradual : Local tenderness to pressure is present Maybe Mild to Severe
Does not present as observed for years without progression of symptoms
Unilateral or bilateral Knife-like quality of stabbing from the inside out, boring, deep aching Cutting, gnawing, Throbbing
Mild to Severe
Recent/sudden Red Flags for Pain 1. Sweats (night or day) 2. Nausea/Vomiting 3. Diarrhea 4. Pallor 5. Dizziness/syncope 6. Fatigue
7. Weight loss 8. Pain at night Vitals • Pulse (beats per minute BPM): ○ Optimal: 60 to 100 BPM
○ Over 100 bpm - tachycardia ○ Below 60 bpm - bradycardia
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