Physical Therapy Case Study

Question: 1. What aspect of the history should alert the therapist to the possibility of a serious pathology? 2. What is the significance of night pain that is unrelated to movement? 3. Although this patient's symptoms resembled radiculopathy and strength testing did not refute the hypothesis, there was nothing in the motion tests to confirm diagnosis. So what is a plausible explanation for the throbbing sensation that the patient experienced? 4. Describe how, as a therapist, you might physically assess the throbbing sensation described by the patient? 5. What clue(s) in the patient's history helped to confirm your assessment in question #3? 6. What techniques or methods do you routinely use to evaluate a patient you suspect has a DVT? After reading this week's articles, would you do anything differently? Answer: 1. In the case study, the patient is reported with a 12-year history of having hypertension and high level of cholesterol. This long-term phenomenon raises a possibility of serious pathology as the high blood pressure through thicker arteries may result in the throbbing problem and the high cholesterol level results in the increase in thickness of the arteries that block the normal blood flow. 2. The cause of night pain without pain may indicate the mechanical problem associated with disc degeneration in the spine. The patient has reported with a throbbing sensation in the right flank and the groin region. Apart from that, the patient is also had a muscle weakness and muscle fatigue was found in the L3-4 distribution. An increase in the muscle tone was also found in the paraspinal muscles ranging in the thoracic lumber region of T9-L4. 3. Symptoms of radiculopathy associated with pain, weakness in the arms and legs and numbness. Radiculopathy is the condition results from the compression of a nerve in the spine that ultimately leads to pain. The patient had a history of doing heavy weight lifting which may lead to disc herniation. A fatigable weakness was also found when the throbbing occurred. After a period of physical therapy with spinal mobilization and exercise session, the patient shows a decrease in muscle tone but having a throbbing experience. The possible reasons behind the throbbing lie in the abnormal blood flow due to an elevation in the artery thickness. The high blood pressure through the thick arteries results in the rhythmic repetition of the pain (Kearon Akl, 2014). 4. The patient has reported of feeling a throbbing sensation in the area of flank and groin region. The throbbing is on the both side of pelvis having the external oblique muscle. To assess the throbbing effect, the patient was subjected to do some physical activities like side stepping, twisting, sprinting and weight lifting. The activities will increase the abdominal pressure and thus will reveal the throbbing effect. Application of gentle pressure to arteries underlying the bone will help to understand the throbbing sensation. The patient is identified with a lodosis within the mid-lumbar region and in the mid thoracic region (Pomero et al., 2013) 5. The patient has a history of having high blood pressure and high cholesterol level. The Patient was prescribed with Valsartan, which in long term shows side effects like back pain, joint pain, dizziness, tired feeling and blurred vision. Hypertension sometimes leads to the throbbing effect due to high blood pressure in the blood vessel. The patient was also having Zocor for the treatment of hyperlipidemia. The side effect of the Zocor results in joint pain, muscle pain and sleeping problems. The high level of cholesterol in the blood accumulates lipid in the blood vessel that ultimately forms a blockage in the artery or vein. The blood clot disrupts the normal blood flow and, in turn, increases the blood pressure. The difficulty of blood flow through blood clot results in the feeling of rhythmic pain (Mirza et al., 2012). 6. As stated by Thachil (2014), when some blood clot occurs in the deep venous system, then it leads to the deep vein thrombosis (DVT). DVT is mainly found in the legs. The clot in the blood vessels very often damages the venous valves that lead to a syndrome called post-thrombotic syndrome (PTS). Pulmonary embolism is another phenomenon occurs due to some blood clots may break off and reach the lungs. The number of DVT patient is increasing, and it has become the third common vascular disease (Sander, 2013). The phenomenon of DVT is associated with endothelial cell line damage of the blood vessel, venous stasis, and circulation of clot factors. Studies have reveled that the occurrence of DVT associated with the immobility for a long period. The risk factors for the DVT are spinal cord injury, hip or knee replacement, chemotherapy and hormonal replacement therapy and obesity with increasing age. There are also such conditions that can mimic the deep vein thrombosis such as acute occl usion, cellulitis, trauma, lower limb paralysis, etc (Goldhaber Bounameaux, 2012). The patient suspected to have deep vein thrombosis need to undergo some physical testing for the identification of the disease. First of all, I will check up the overall health condition of the patient. It is important to check the previously prescribed medicine, which the patient was taking. I need to check whether the patient has undergone any surgeries or injury in recent times or not. Furthermore, I have to check on the malignancy status of the patient. During the physical examination, I will check the lower extremities of the patient to look for signs of deep vein thrombosis (Huisman Klok, 2013). I need to check up the blood pressure and the heart and lungs condition of the patient in a regular manner. The patient needs to undergo some diagnostic tests as well. Ultrasound method is very effective to determine the DVT. Ultrasound helps to create pictures of the blood flow through the arteries and vein in the affected legs by using the sound waves. If the ultrasound does not prov ide the clear image of the vein, then a dye is injected into the vein, and an X-Ray report of the leg is taken. The dye helps the vein to visible in the X-Ray, and the clots can easily point out, which is known as venography. Another test known as the D-dimer test is performed to measure the substance in the blood that released after the blood clot dissolves. If the high level of substance occurs then, the presence of deep vein thrombosis indicates (Anderson et al., 2009). After reading the article, I will focus on the clinical decision rules to measure and analyze the risk factors in more sophisticated way. The majority of the important information of clinical trials are incorporated into the CDR score to determine the probability of the DVT. The diagnosis by magnetic resonance imaging and computed tomography will give a more clear idea about the blood clots in the vein. References Anderson, C. M., Overend, T. J., Godwin, J., Sealy, C., Sunderji, A. (2009). Ambulation after deep vein thrombosis: A systematic review.Physiotherapy Canada. Physiothrapie Canada,61(3), 133-140. doi:10.3138/physio.61.3.133 Goldhaber, S. Z., Bounameaux, H. (2012). Pulmonary embolism and deep vein thrombosis.The Lancet,379(9828), 1835-1846. Huisman, M. V., Klok, F. A. (2013). Diagnostic management of acute deep vein thrombosis and pulmonary embolism.Journal of Thrombosis and Haemostasis,11(3), 412-422. Kearon, C., Akl, E. A. (2014). Duration of anticoagulant therapy for deep vein thrombosis and pulmonary embolism.Blood,123(12), 1794-1801. Mirza, A. F., Mo, J., Holt, J. L., Kairalla, J. A., Heft, M. W., Ding, M., Ahn, A. H. (2012). Is there a relationship between throbbing pain and arterial pulsations?The Journal of Neuroscience : The Official Journal of the Society for Neuroscience,32(22), 7572-7576. doi:10.1523/JNEUROSCI.0193-12.2012 Pomero, F., Dentali, F., Borretta, V., Bonzini, M., Melchio, R., Douketis, J. D., Fenoglio, L. M. (2013). Accuracy of emergency physicianperformed ultrasonography in the diagnosis of deep-vein thrombosis.Thrombosis and haemostasis,109(1), 137-145. Sander, R. (2013). Identifying deep vein thrombosis.Nursing Older People,25(9), 15 Thachil, J. (2014). Deep vein thrombosis.Hematology (Amsterdam, Netherlands),19(5), 309.