Assignment 1

1480 words - 6 pages

In physical therapy, patients come to the clinic with a long list of symptoms and a specific mechanism of injury. It is the physical therapists job to take this information and form hypotheses of what pathology may be affecting the patient. With the patient that has been presented in this case, a full history shows a very good description of symptoms and what the patient remembers happening when the injury occurred. With this history, an examination plan can be created in order to make this examination process thorough, but efficient.
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.
There are several tests and measure that can be done in a physical therapy examination in order to rule out certain diagnoses, as well as come closer to a physical therapy diagnosis. First, an observation of the patient standing, walking, and sitting should be done in order to associate any visible deficits in the patient that could be associated to the signs and symptoms a physical therapist may see. Comparing the affected side to the unaffected side is very important to note any structural, dynamic, or functional differences in the patient’s body. Next, any red flags should be ruled out. The patient did have imaging done, but even with imaging being very advanced there can still be some limitations that will cause some missed diagnoses (Shabat, Leitner, David, & Folman, 2012, p. 375). That is why it is still important to perform red flag testing to keep the patient as safe as possible. Red flag tests indicate if something potentially dangerous or life threatening is going on with the patient. This will cause a physical therapy examination to stop and that patient may be referred to their primary care physician for further care before physical therapy can proceed. These tests include vertebral artery testing and cervical instability testing (Dutton, 2012). The vertebral artery test rules out any blood supply being cut off to the brain (Magee, 2008, p. 150). In terms of cervical instability testing, the transverse ligament and alar ligament tests should be done to avoid any bones in the cervical spine moving out of place to damage the spinal cord (Magee, 2008, p. 180)....

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