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case study in physiotherapy.........pptx
- 1. CASE PRESENTATION DR. AMAN HUSSAIN(PT) (MPT 1ST YEAR){SPORTS} 230310026
- 3. DEMOGRAPHIC DATA Name: Mr. Adarsh Singh Age: 23 years Gender: Male Occupation: Student Address: Gurgaon, Haryana C.R. No. : 100658393 Date of 1st assessment: 31st October 2023 Date of last assessment: 10th November 2023
- 4. Chief Complaint: Pain in lower back and lateral thigh region of left lower limb.. Heaviness and limp in the left lower limb since 40 days.
- 5. Present History: • Patient was apparently well before 2 months then he started feeling pain in his low back while he was performing squat in gym with weight where he felt a sudden click in his back centrally followed by limping in his left lower limb, next day he also started feeling pain in lateral aspect of thigh region in left L/L. Then he came to SGT hospital and consulted with neurosurgeon and was prescribed some analgesics and been referred to physiotherapy department same day for further evaluation and treatment.
- 6. Past history: • Patient had a history of low back pain from 8 months then he went to Rama Hospital, Kanpur where he was diagnosed with some postural abnormality and treated with some analgesics and multivitamin medications and postural exercises.
- 7. MEDICALAND SURGICAL HISTORY : Medical history : No history of DM/TH/TB/Asthma/HTN Surgical history: Not Present Family History: Not Present Personal History: Vegetarian, Non alcoholic, Sleep disturbed due to pain (when changing positions), Bowel & bladder function-normal, Chronic Smoker (2 ciggaretes/day from 5years) Socioeconomic status: Upper Middle class(Revised kuppuswamy scale, 2020)
- 8. VAS: 7-8 (Activity and walking) 2-3 (At Rest) Onset: Gradual Site: Low back L4-L5-S1, left lateral thigh Nature of pain: Continuous Type: Dull aching(low back) and burning pain in left L/L. Aggravating factor: Walking and long time sitting Releiving factors: Analgesic medications, Rest in supine Pain History
- 9. On Observation 1) Patient’s Body Type: Mesomorphic 2) Trophic changes: Not present 3) Scar: Not present 4) Swelling: Not present
- 10. Postural Examination:- Anterior:- • Shoulder levels normal • ASIS levels are normal • Weight bearing Rt>Lt
- 11. Posterior:- • Right shoulder elevated • PSIS normal • Left knee slight flexed • Left foot pronated
- 12. Lateral View:- • Right shoulder retracted • Forward head posture • ASIS&PSIS in line • Left knee slightly flexed Lt. Rt.
- 13. Gait examination:- • Weight bearing Rt>Lt lower limb • Reduced arm swing
- 14. ON PALPATION Temperature: Normal (Lower back) Oedema: Not present Tenderness: Present (reference: orthopedic physical assessment) • Site: • Over B/L paraspinal and spinal region L4-L5-S1 (Grade 2) • Over left L/L TFL area (Grade 1) Spasm : Not present
- 15. Lumbar Spine (Active range of motion) Manual Muscle Testing Flexion Limited, Painful 4 Extension Full, Painfree 4 Side Flexion Right- Full, Painfree Left- Full, Painfree Right-4 Left-4 Rotation Right- Full, Painfree Left- Full, Painfree Movement Examination: Range of Motion & Manual Muscle Testing * *Muscle tesing and function (Kendall)
- 16. Hip Active range of motion Passive Range of Motion Manual Muscle Testing Right Left Right Left Right Left Flexion (120°) 100° 40° (Limited, Painful) 110° 60° (Limited, Painful) 4 4 Extension (35°) 25° (Limited, painfree) 25° (Limited, Painfree) 30° 25° (Limited, Painfree ) 4 4 Abduction (55°) 45° 30° (Limited, Painful) 45° 40° 4 4 Adduction (0°) 45-0° 45-0° 45-0° 45-0° 4 4 Lateral Rotation (45°) (In high sitting) 35° 30° 40° 35° 4 4 Medial Rotation (35°) 30° 30° 35° 35° 4 4
- 17. Right Left Difference True 43 43 0 Apparent 43 42.5 0.5 Limb length measurements (in cm): Not evident ory Examination:- All sensations are intact and normal. Knee and ankle reflex:- Normal
- 18. DIFFERENTIAL DIAGNOSIS:- Differential diagnosis Clinical presentation Correlation with present case Piriformis Syndrome Sitting intolerance , pain radiating along the posterior part of thigh Piriformis stress test:- -ve Piriformis tenderness not present PIVD Radiating pain , numbness and tingling sensation in lower extremities ,pain can occur in bending SLR Test:- +ve Slump test:- +ve Flexion painful Spondylolisthesis Pain with spinal extension and radiates to lower extremities, positive step sign, reduces with flexion Step Sign:- N/P Pain aggravates with flexion SI Joint dysfunction Pain radiating to buttock and back of thigh , sitting intolerance ,local tenderness at PSIS ,pain in bending forward SI joint tests:- -ve No tenderness around SI
- 19. Special Tests: 1. SLR: Positive (0-35 degrees) (Left) 2. Faber’s Test:- Negative (B/L)
- 20. 3. Gaenslen’s test: Left: Negative, Right: Negative 4. Gillet Test:- Negative
- 21. 5. Slump test: Left: Positive, Right: Negative 6. Trendelenburg Sign:- Not present 7. SI Compression test: Negative
- 22. MRI investigation: Pelvis and lumbar spine Date: 13th October 2023
- 24. DIAGNOSIS:- • PIVD L4-L5 and L5-S1 mild posterocentral disc protrusion resulting in impingement of exiting nerve roots.
- 25. Physiotherapy Management Short term goals • To educate patient about faulty posture and symptoms • To develop awareness and control of spinal posture • To provide symptomatic pain relief • To correct the posture • To increase mobility in restricting musculature
- 26. Long term goals: • To develop strength and endurance in postural and extremity muscles • To emphasize habitual use of techniques of stress relief/ relaxation and posture correction. • To promote healthy exercise habits for self-maintenance
- 27. WEEK: 1 1) For Pain Relief: • Hot pack: 12-15 mins Position: Over low back and Gluteal region • 4 channel Tens:- Conventional mode of TENS Frequency: 120 Hz, for 15minutes Site:- Over Low back and lateral thigh • Ultrasound:- - Frequency of ultrasound- 3Mhz Pulse Mode – 1:4 (To promote Healing) Intensity – 0. 8W/ cm2 Time –6 minutes Site:- Over L4-L5-S1 area
- 28. 2.) Mckenzie Exercises:- (To reduce pain and Improve condition) Prone on elbows 4 sets of 10 seconds hold Prone on hands 4 sets of 10 seconds hold
- 29. 3.) Lumbar Traction:- To:- • Reduce symptoms and pain • Reduce compression on nerve roots • Improve mobility of spine
- 30. WEEK: 2 • After Pain reduced toVAS 4 during activity. • SLR Negative Stretchings to improve mobility Calf stretch (affected limb) Hamstrings and calf stretch(painfree range)
- 31. Piriformis stretch TFL and IT band stretch
- 32. Pelvic Bridging Gluteus maximus strengthening
- 33. Reassessment:- 10th November 2023 Reduced pain to VAS 2 Improved symptoms Improved posture and gait Improved overall condition and confidence
- 34. Ergonomics and Home Exercise program • To follow ergonomics for low back • Pain relief : hot packs 3 times a day each for 12 min or muscle relaxant spray • To perform Self- stretching exercises for piriformis,hamstrings,calf,Pectoralis and upper traps. • Pelvic bridging:- 4sets of 15seconds hold • Prone Plank:- 3sets of 30 seconds hold • Mckenzie exercises • Use of intermittent Lumbar corset belt/LS belt during long standing and activity