SUBJECTIVE Patient referred to physical therapy to evaluate diffuse upper back and neck pain. She was involved in a motor vehicle accident like three years ago and never had any post accident injuries. She notes mostly central _____ cervical and upper thoracic pain and occasional headaches that may or may not be cervically related. Denies any radicular symptoms. Seems to be better when she is either slouched with her head supported and worse when she has to sit upright and hold her posture. OBJECTIVE Healthy-looking young 20-year-old female no obvious things to note on observation. She essentially had full cervical range of motion, normal upper extremity range of motion and strength. Palpation had exquisite tenderness along the upper
Based on the initial pain medicine evaluation report dated 06/22/15, the patient complains of constant neck pain which radiates down to the bilateral upper extremity, fingers and hands. Pain is accompanied by intermittent tingling and numbness in the bilateral upper extremities to the level of the fingers and muscle weakness. The neck pain is associated with occipital, temporal and frontal headaches and muscle spasms in the neck area. The patient describes the pain as aching, burning, pins and needles, sharp, and stabbing. The pain is aggravated by activity, flexion/extension, prolonged sitting, pulling, pushing, repetitive head motions and standing. She also reports severe difficulty in sleep.
It’s a “nonlesion” syndrome , exhibit no clinically detectable lesions, although symptoms of pain and burning can be intense. This is particularly frustrating problem for both patient and clinician, because there is usually no clear cut cause and no uniformly successful treatment is present.
J.P., a 58 year old female, presents to the Emergency Room on March 18th. She has a past medical history of cervical cancer, atheroembolism of the left lower extremity, fistula of the vagina, peripheral vascular disease, neuropathy, glaucoma, GERD, depression, hypertension, chronic kidney disease, and sickle cell anemia. She complains of right lower extremity pain accompanied by fatigue, a decreased appetite, increased work of breathing, burning urination, and decreased urine output for three days. Upon admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings.
A hypothesis that can be made from the patient’s report is that she is suffering from cervical radiculopathy, or a nerve root lesion. Symptoms that describe cervical radiculopathy include: arm pain in a dermatome distribution, pain increased by extension, rotation, and/or side flexion, possible relief of pain from arm positioned overhead, affected sensation, altered hand function, no spasticity, and no change to gait or bowel and bladder function (Magee, 2008, p. 142). These symptoms correlate to what the patient reported as a result of her injury. She stated that her pain is in the posterolateral upper and lower arm with aching and paresthesia in the thumb and index finger, which is in the dermatome pattern of cervical root 5 and 6 (C5, C6) (Magee, 2008, p. 25). She also reports lancinating pain with extension or rotation to the right of her head.
III. REASON FOR SEEKING CARE (CC): 38 y/o female c/o abdominal pain throughout the entire abdominal cavity, states she has always had abdominal discomfort, but the past 3 days’ pain has become unbearable. Describes pain as a burning churning through out 8/10. Pain intermittent c/o of sour stomach after meals accompanied by nausea, denies vomiting, diarrhea or anorexia, last bowel movement 4 days ago. States she moves bowels 2-3 times a week. She states this happened about 2 years she went to emergency room, CT was done, no blockage, she was sent home without meds, CT contrast helped her move bowels at the time, symptoms eventually resolved on their own. Pt c/o of waking up feeling unrested, had trouble falling asleep ever since she could remember, wakes up frequently with difficulty getting back to sleep. She reports sleep disorder sometimes coincide with inability to get comfortable due to shoulder and neck pain especially in the winter months. Pt states the head and shoulder pain are the result of a MVI in 1995 where she had spinal nerve damage and bulging disc.
Identifying Data: R.S. is a 28 year old Indian female of Indian-American of Asian descent. She is a full time nursing student currently residing in Rochester. She is single and does not have children. Patient presents today complaining of pressure headaches and is alone.
Voci’s physician assistant for a lengthy appointment. The recent EMG of the upper extremities showed mild carpal tunnel to the right hand, there was no radiculopathy from the cervical spine, the EMG of the lower extremities was normal with any radiculopathy of the lower extremities. The VNG for vertigo was negative. A recent MRI of the lumbar spine showed bulges at L3/L4, narrowing, bulges at L4/5, L5/Si. Ms. Tocco again expressed how helpless she feels with her pain, balance, migraines, and jaw pain. It has affected her whole life. She has a lot of anxiety related to her current continued symptoms. She said Dr. Morelli wants her to have some epidural injection, but also told her she would need to have another cervical spine surgery to repair the damage from the original repair not healing. In the meantime, medications are being changed to try and get the migraines under control, Cambia and Maxalt will be tried. She can take a Norco at twice a day and will continue with the Cyclobenzaprine. We talked about the recommendation by the physical therapist to try therapeutic massage. We obtained a
The following physical therapy intervention will address all of the following deficits: BPPV/vertigo, balance, weakness, and cervical ROM. Initially the main concern for intervention will be treating the BPPV and vertigo symptoms. Since this patient is suffering from right posterior canal BPPV we will use the Epley maneuver to move the dislodged otoconia back into the otolith organs. BPPV and vertigo often resolves after the first Epley however, depending on the individual it may take additional sessions.
Bratton, R. L., Whiteside, J. W., Hovan, M. J., Engle, R. L., Edwards, F. D. (2008). Diagnosis
My journey to pursue an education in physical therapy actually originates from my early childhood. I endured a very impoverished upbringing and my family’s socioeconomic status was below the poverty line. At a very young age, money became the central issue of my life. I found myself worrying about mortgages, health bills, and grocery money. As I grew older, I vowed to myself that I would not endure my family’s financial burdens into my adulthood. I knew the best way to accomplish this was by obtaining a college degree and having a professional career. However, I was unsure what career I wanted to pursue. I experimented with many different career ideas, but during my sophomore, I discovered my passion and skill for physical medicine. For my
In this case, a 53 y /o man came to sports medicine clinic after two weeks of surgical repair of the rotator cuff. The physical therapist (PT) performed an initial examination of the patient. She started with active exercises and gradually progressed to variety of resisted exercises during the next two weeks of treatment. On the final scheduled patient’s visit, the PT asked the athletic trainer (also the clinic manager) to supervise intervention while she attended meeting in another part of the facility. She told ATC to stretch the patient’s shoulder and then put ice on it.
The first day that I met Izzy (name used with consent) I noticed a huge smile, a cheerful laugh and a big personality; the wheelchair immediately faded into the background. Izzy has become a large part of my life as I have seen her mature while watching her disease progress. I have learned that behind the smile there are many details that have allowed her to live at home, to go to school and to develop her independence. These details are tailored to her individual needs and originate from her team that includes Izzy, her family and her healthcare workers. One of her healthcare workers, an occupational therapist, is my aunt who works in the school system and supports school age children/teens with physical and/or mental disabilities to succeed in school. I was introduced to Izzy when she was starting school and over the years I have seen the enormous impact that occupational therapy has made for Izzy, her family and her school community. Her occupational therapist made a pencil grip so that Izzy could write and then provided computer access through a keyboard and then a voice activated system.
If you play sports or are interested in the sporting world, then you may know that an ACL injury can be a nightmare to your playing time or success in your game. But what happens after you survive surgery? Well, If you’ve had this type of accident then you know Physical Therapy is prescribed so that you can be rehabilitated and get back into your passion. This type of therapy is important because injuries such as ACL, meniscus, rotator cuff, and labral tears can be troublesome for the rest of your life. But the question is, what did it take for your Physical Therapist to get to his or her position? What do they sacrifice and What does the future look like for this profession.
Each patient receives a comprehensive examination using objective and subjective measures to assess pain, movement patterns, muscle performance, posture, endurance, flexibility, joint accessory motion, and a detailed medical history in order to identify the underlying cause of symptoms. Getting to the root cause of the issue allows us to more effectively treat the problem and devise a personalized treatment plan.
Physical therapy is a fun and exciting healthcare profession that helps people. It is all about helping other people who have problems with their body, muscles, joints and other parts of their body. Patients includes accident victims and individuals with disabling conditions such as low back pain, arthritis, heart disease, fractures, head injuries, and cerebral palsy. Physical therapy will perform an evaluation of your problem or difficulty. They evaluate your problem by performing tests and measures to assess the problem. These tests includes muscle strength, joint motion, sensory and neurological, coordination, balance, observation, palpation, flexibility, postural screening, movement analysis, and special tests are designed for a particular problem. Next, they develop a treatment plan and goals and then manage the appropriate treatment to aid in recovery of a problem or dysfunction. Physical therapists are able to treat their patients by using many different treatments depending on the type of injury. Some of the treatments are electrical stimulation, hot and cold packs, infrared and ultrasound to reduce swelling or relieve pain. These treatments are used to help decrease pain and increase movement and function. Therapeutic exercises instructions will help restore strength, movement, balance, or skill as a guide towards full functional recovery. Physical therapy provides "hands on techniques" like massage or joint mobilizations skills to restore joint motion or increase soft tissue flexibility. They will focus on basic skills such as getting out of bed, walking safely with crutches or a walker, moving specific joints and muscles of the body. Physical therapists treatment includes patient education to teach them how to deal with a current problem and how to prevent the problem in the future. Such documentation is used to track the patient's progress, and identify areas requiring more or less attention. They encourage patients to use their own muscles. Their main goal is to improve how an individual functions at work and home.